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Audit of Hospital Stay Saves Member $4,923.03

With DirectAccess+™, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and health plans. Utilizing the median commercially contracted price gives a fair estimate on the true savings being generated for the plan and the member. Licensed healthcare professionals conduct comprehensive line-by-line claim auditing to uncover errors typically not caught. Following are five recent audit results showcasing substantial savings.

1. Spartanburg, South Carolina

Six-day hospital stay for the treatment of pneumothorax and related surgery.

High-Dollar Services

• Room and Board: $23,562

Traditional Network Plan Hospital Bill: $67,841.42 Median Commercially Contracted Price $41,257 Patient Responsibility 20% Coinsurance: $8,251.40

DirectAccess+™ Hospital Bill: $67,841.42 ClaimDOC Allowable $16,641.86 Patient Responsibility 20% Coinsurance: $3,328.37 Plan Savings: $24,615.14 Member Savings: $4,923.03

2. Houston, Texas

Seven-day hospital stay for the treatment of sepsis, diabetes and cellulitis (right leg).

High-Dollar Services

• Pharmacy: $35,859

Traditional Network Plan Hospital Bill: $101,623.50 Median Commercially Contracted Price $28,901 Patient Responsibility 20% Coinsurance: $5,780.20

DirectAccess+™ Hospital Bill: $101,623.50 ClaimDOC Pricing: $20,643.14 Patient Responsibility 20% Coinsurance: $4,128.63 Plan Savings: $8,257.86 Member Savings: $1,651.57

3. Peoria, Illinois

Two-day hospital stay for the treatment of immune thrombocytopenia purpura.

High-Dollar Services

• Pharmacy: $79,233.95

Traditional Network Plan Hospital Bill: $90,126.25 Median Commercially Contracted Price $23,643.36 Patient Responsibility 20% Coinsurance: $4,728.67

DirectAccess+™ Hospital Bill: $90,126.25 ClaimDOC Pricing: $16,477.13 Patient Responsibility 20% Coinsurance: $3,295.43 Plan Savings: $7,166.23 Member Savings: $1,433.25

4. St. Petersburg, Florida

Two-day hospital stay for cesarean delivery with maternal complications.

High-Dollar Services

• Operating Room: $22,403

Traditional Network Plan Hospital Bill: $69,993.52 Median Commercially Contracted Price $18,112 Patient Responsibility 20% Coinsurance: $3,622.40

DirectAccess+™ Hospital Bill: $69,993.52 ClaimDOC Pricing: $12,004.86 Patient Responsibility 20% Coinsurance: $2,400.97 Plan Savings: $6,107.14 Member Savings: $1,221.43

5. Spokane Valley, Washington

Hospital outpatient services for the treatment of cervical dysplasia and related surgery.

High-Dollar Services

• Operating Room: $42,911

Traditional Network Plan Hospital Bill: $52,707.96 Median Commercially Contracted Price $18,106.99 Patient Responsibility 10% Coinsurance: $1,810.70

DirectAccess+™ Hospital Bill: $52,707.96 ClaimDOC Pricing: $13,124.01 Patient Responsibility 10% coinsurance: $1,312.40 Plan Savings: $4,982.98 Member Savings: $498.30

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Disclaimer — The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal or financial advice.