Audit Cases Feb 27, 2026

Member Saves $10K After Complicated Childbirth

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. Allentown, Pennsylvania

Five-day hospital stay for the delivery of a newborn by cesarian section with complications.

Traditional Network Plan

  • Hospital Bill: $233.761.46
  • Median Commercially Contracted Price
    • $121,310.01
  • Patient Responsibility 20% Coinsurance:
    • $24,262.00

DirectAccess+

  • Hospital Bill: $233.761.46
  • ClaimDOC Allowable:
    • $71,271.45
  • Patient Responsibility 20% Coinsurance:
    • $14,254.29
  • Plan Savings: $50,038.56
  • Member Savings: $10,007.71

2. Nashville, Tennessee

Eight-day hospital stay for the treatment of obesity, diabetes, heart disease and related surgery.

Traditional Network Plan

  • Hospital bill: $234,572.70
  • Median commercially contracted price
    • $96,943.40
  • Patient responsibility (20% coinsurance):
    • $19,388.68

DirectAccess+

  • Hospital bill: $234,572.70
  • ClaimDOC allowable
    • $53,870.21
  • Patient responsibility (20% coinsurance):
    • $10,774.04
  • Plan Savings: $43,073.19
  • Member Savings:  $8,614.64

3. Plano, Texas

Five-day hospital stay for the delivery of a newborn by cesarian section with complications.

Traditional Network Plan

  • Hospital bill: $97,039.63
  • Median commercially contracted price
    • $23,225.35
  • Patient responsibility (15% coinsurance):
    • $3,483.80

DirectAccess+

  • Hospital bill: $97,039.63
  • ClaimDOC allowable
    • $12,646.64
  • Patient responsibility (15% coinsurance):
    • $1,897.00
  • Plan Savings: $10,578.71
  • Member Savings:  $1,586.80

4. Durant, Oklahoma

Two-day hospital stay for the treatment of osteoarthritis of left hip and related surgery.

Traditional Network Plan

  • Hospital Bill: $264,739.08
  • Median Commercially Contracted Price
    • $35,907.11
  • Patient Responsibility 20% Coinsurance:
    • $7,181.42

DirectAccess+

  • Hospital Bill: $264,739.08
  • ClaimDOC Allowable:
    • $18,683.69
  • Patient Responsibility 20% Coinsurance:
    • $3,736.74
  • Plan Savings: $17,223.42
  • Member Savings: $3,444.68

5. Nashville, Tennessee

Seven-day hospital stay for the treatment of acute kidney failure with complications.

Traditional Network Plan

  • Hospital Bill: $225,095.40
  • Median Commercially Contracted Price
    • $81,897.14
  • Patient Responsibility 10% Coinsurance:
    • $8,189.71

DirectAccess+

  • Hospital Bill: $225,095.40
  • ClaimDOC Allowable:
    • $48,221.69
  • Patient Responsibility 10% Coinsurance:
    • $4,822.17
  • Plan Savings: $33,675.45
  • Member Savings: $3,367.55

 

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.