Audit Cases Jan 27, 2026

Member Saves Over $23K While Audit Reduces Plan Cost by Nearly $117K

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. Myrtle Beach, South Carolina

One-day hospital stay for the treatment of heart attack and cardiac arrest.

Traditional Network Plan

  • Hospital Bill: $298,889.50
  • Median Commercially Contracted Price
    • $146,017.05
  • Patient Responsibility 20% Coinsurance:
    • $29,203.41

DirectAccess+

  • Hospital Bill: $298,889.50
  • ClaimDOC Allowable:
    • $29,310.41
  • Patient Responsibility 20% Coinsurance:
    • $5,862.08
  • Plan Savings: $116,706.64
  • Member Savings: $23,341.33

2. Orlando, Florida

Twelve-day hospital stay for the treatment of cancer of the retroperitoneum and related surgery.

Traditional Network Plan

  • Hospital bill: $253,763.22
  • Median commercially contracted price
    • $116,035
  • Patient responsibility (20% coinsurance):
    • $23,207

DirectAccess+

  • Hospital bill: $253,763.22
  • ClaimDOC allowable
    • $50,813.79
  • Patient responsibility (20% coinsurance):
    • $10,162.76
  • Plan Savings: $65,221.21
  • Member Savings:  $13,044.24

3. Indianapolis, Indiana

Seven-day hospital stay for the treatment of aneurysm of the aorta and related surgery.

Traditional Network Plan

  • Hospital bill: $374,524.89
  • Median commercially contracted price
    • $130,251.91
  • Patient responsibility (20% coinsurance):
    • $26,050.38

DirectAccess+

  • Hospital bill: $374,524.89
  • ClaimDOC allowable
    • $67,024.30
  • Patient responsibility (20% coinsurance):
    • $13,404.86
  • Plan Savings: $63,227.61
  • Member Savings:  $12,645.52

4. Miami, Florida

Sixteen-day hospital stay for the treatment of Chrohn’s disease and related surgery.

Traditional Network Plan

  • Hospital Bill: $288,323
  • Median Commercially Contracted Price
    • $122,450.72
  • Patient Responsibility 20% Coinsurance:
    • $24,490.14

DirectAccess+

  • Hospital Bill: $288,323
  • ClaimDOC Allowable:
    • $63,836.37
  • Patient Responsibility 20% Coinsurance:
    • $12,767.27
  • Plan Savings: $58,614.35
  • Member Savings: $11,722.87

5. West Hollywood, California

Three-day hospital stay for the treatment of spinal stenosis, collapsed vertebrae and related surgery.

Traditional Network Plan

  • Hospital Bill: $225,095.40
  • Median Commercially Contracted Price
    • $42,993.97
  • Patient Responsibility 10% Coinsurance:
    • $4,299.40

DirectAccess+

  • Hospital Bill: $225,095.40
  • ClaimDOC Allowable:
    • $29,013.71
  • Patient Responsibility 10% Coinsurance:
    • $2,901.37
  • Plan Savings: $13,980.26
  • Member Savings: $1,398.03

 

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.