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Audit Saves Plan $16,116.80 on Claim

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. Tulsa, Oklahoma

Six-day hospital stay for the treatment of second-degree burn, corrosion of left foot and related surgery

Traditional Network Plan Hospital Bill: $108,708.07 Median Commercially Contracted Price $38,249.29 Patient Responsibility 20% Coinsurance: $7,649.86

DirectAccess+ Hospital Bill: $108,708.07 ClaimDOC Allowable $22,132.49 Patient Responsibility 20% Coinsurance: $4,426.50 Plan Savings: $16,116.80 Member Savings:  $3,223.36

2. Sacramento, California

One-day hospital stay for the treatment of hydronephrosis, obstruction and related surgery

Traditional Network Plan Hospital Bill: $53,073.65 Median Commercially Contracted Price $25,136 Patient Responsibility 20% Coinsurance: $5,027.20

DirectAccess+ Hospital Bill: $53,073.65 ClaimDOC Allowable: $15,478.64 Patient Responsibility 20% Coinsurance: $3,095.73 Plan Savings: $9,657.36 Member Savings: $1,931.47

3. Key West, Florida

Two-day hospital stay for the treatment of cellulitis in left lower leg and related surgery

Traditional Network Plan Hospital Bill: $62,586.54 Median Commercially Contracted Price $34,834.56 Patient Responsibility 10% Coinsurance: $3,483.46

DirectAccess+ Hospital Bill: $62,586.54 ClaimDOC Allowable: $27,487.76 Patient Responsibility 10% Coinsurance: $2,748.78 Plan Savings: $7,346.80 Member Savings: $734.68

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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.