Audit Cases Nov 25, 2025

Audit Saves Plan $18,412.58 After Member’s Hospital Stay

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, according to Turquoise Health, 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. York, Maine

One-day hospital stay for the treatment of pain due to internal orthotic device and related surgery

Traditional Network Plan

  • Hospital bill: $78,866.50
  • Median commercially contracted price
    • $43,587.11
  • Patient responsibility (20% coinsurance):
    • $8,717.42

DirectAccess+

  • Hospital bill: $78,866.50
  • ClaimDOC allowable
    • $25,174.53
  • Patient responsibility (20% coinsurance):
    • $5,034.91
  • Plan Savings: $18,412.58
  • Member Savings:  $3,682.51

2. Riverview, Florida

One-day hospital stay for the treatment of hemorrhage following spontaneous abortion and related procedure

Traditional Network Plan

  • Hospital Bill: $54,702.17
  • Median Commercially Contracted Price
    • $24,349.50
  • Patient Responsibility 20% Coinsurance:
    • $4,869.90

DirectAccess+

  • Hospital Bill: $54,702.17
  • ClaimDOC Allowable:
    • $9,343.13
  • Patient Responsibility 20% Coinsurance:
    • $1,868.63
  • Plan Savings: $15,006.37
  • Member Savings: $3,001.27

3. Davenport, Florida

Four-day hospital stay for the treatment of infectious gastroenteritis, colitis and sepsis

Traditional Network Plan

  • Hospital Bill: $76,912.03
  • Median Commercially Contracted Price
    • $35,231.91
  • Patient Responsibility 20% Coinsurance:
    • $7,046.38

DirectAccess+

  • Hospital Bill: $76,912.03
  • ClaimDOC Allowable:
    • $13,648.26
  • Patient Responsibility 20% Coinsurance:
    • $2,729.65
  • Plan Savings: $21,583,65
  • Member Savings: $4,316.73

4. Plano, Texas

Seven-day hospital stay for the treatment of closed left ilium fracture due to car accident and related surgery and vertebral fracture

Traditional Network Plan

  • Hospital Bill: $193,235.17
  • Median Commercially Contracted Price
    • $44,751.28
  • Patient Responsibility 20% Coinsurance:
    • $8,950.26

DirectAccess+

  • Hospital Bill: $193,235.17
  • ClaimDOC Allowable:
    • $21,448.32
  • Patient Responsibility 20% Coinsurance:
    • $4,289.67
  • Plan Savings: $23,302.96
  • Member Savings: $4,660.59

5. Dekalb, Illinois 

Five-day hospital stay for the treatment of duodenitis & biliary acute pancreatitis and related surgery

Traditional Network Plan

  • Hospital Bill: $52,777.22
  • Median Commercially Contracted Price
    • $25,204.75
  • Patient Responsibility 10% Coinsurance:
    • $2,520.48

DirectAccess+

  • Hospital Bill: $52,777.22
  • ClaimDOC Allowable:
    • $13,296.73
  • Patient Responsibility 10% Coinsurance:
    • $1,329.67
  • Plan Savings: $11,908.02
  • Member Savings: $1,190.80

 

Disclaimer — The analysis of any medical billing or coding is dependent on numerous facts, regulations, payor 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.