Audit Cases Dec 29, 2025

Claim Audit Delivers $48,336.27 in Plan Savings

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. Savannah, GA

Ten-day hospital stay for the treatment of morbid obesity, and respiratory and kidney failure

Traditional Network Plan

  • Hospital Bill: $245,790
  • Median Commercially Contracted Price
    • $97,312
  • Patient Responsibility 30% Coinsurance:
    • $29,193.60

DirectAccess+

  • Hospital Bill: $245,790
  • ClaimDOC Allowable:
    • $48,975.73
  • Patient Responsibility 30% Coinsurance:
    • $14,692.72
  • Plan Savings: $48,336.27
  • Member Savings: $14,500.88

2. Gainesville, FL

Nineteen-day hospital stay for the treatment of aortic aneurysm and related surgery

Traditional Network Plan

  • Hospital bill: $166,346.51
  • Median commercially contracted price
    • $55,444.79
  • Patient responsibility (20% coinsurance):
    • $11,088.96

DirectAccess+

  • Hospital bill: $166,346.51
  • ClaimDOC allowable
    • $21,933.64
  • Patient responsibility (20% coinsurance):
    • $4,386.73
  • Plan Savings: $33,511.15
  • Member Savings:  $6,702.23

3. Plano, TX

One-day hospital stay for the treatment of heart block, diabetes, kidney failure and morbid obesity

Traditional Network Plan

  • Hospital bill: $857,154.05
  • Median commercially contracted price
    • $114,911
  • Patient responsibility (30% coinsurance):
    • $34,473.30

DirectAccess+

  • Hospital bill: $857,154.05
  • ClaimDOC allowable
    • $86,212.58
  • Patient responsibility (30% coinsurance):
    • $25,863.77
  • Plan Savings: $28,698.42
  • Member Savings:  $8,609.53

4. Phoenix, AZ

Seven-day hospital stay for the treatment of heart attack and related surgery

Traditional Network Plan

  • Hospital Bill: $452,547.99
  • Median Commercially Contracted Price
    • $77,158.74
  • Patient Responsibility 20% Coinsurance:
    • $15,431.75

DirectAccess+

  • Hospital Bill: $452,547.99
  • ClaimDOC Allowable:
    • $60,791.49
  • Patient Responsibility 20% Coinsurance:
    • $12,158.30
  • Plan Savings: $16,367.25
  • Member Savings: $3,272.45

5. Nashville, TN

Four-day hospital stay for the treatment of jawbone fracture due to fight/brawl

Traditional Network Plan

  • Hospital Bill: $194,967.89
  • Median Commercially Contracted Price
    • $35,974.37
  • Patient Responsibility 20% Coinsurance:
    • $7,194.87

DirectAccess+

  • Hospital Bill: $194,967.89
  • ClaimDOC Allowable:
    • $21,538.55
  • Patient Responsibility 20% Coinsurance:
    • $4,307.71
  • Plan Savings: $14,435.82
  • Member Savings: $2,887.16
   

 

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.