Audit Saves Plan Over $32K After Member’s Heart Attack
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.
Avenel, New Jersey
A two-day hospital stay for the treatment of a heart attack and related procedure.
Hospital bill: $73,397.11
|
Plan |
Patient Responsibility* |
|
|
Traditional Network Plan |
$50,467.63** |
$10,093.53 |
|
DirectAccess+ |
$18,437.91*** |
$3,687.58 |
*20% coinsurance | **Median commercially contracted price | ***ClaimDOC allowable
Plan savings: $32,029.72 | Member savings: $6,405.95
Ada, Oklahoma
A two-day hospital stay following a stroke.
Hospital bill: $79,704.50
|
Plan |
Patient Responsibility* |
|
|
Traditional Network Plan |
$40,369.48** |
$8,073.90 |
|
DirectAccess+ |
$17,950.68*** |
$3,590.14 |
*20% coinsurance | **Median commercially contracted price | ***ClaimDOC allowable
Plan savings: $22,418.80 | Member savings: $4,483.76
Orlando, Florida
A six-day hospital stay for the treatment of aphasia and hemiplegia following a stroke.
Hospital bill: $146,279.75
|
Plan |
Patient Responsibility* |
|
|
Traditional Network Plan |
$30,486.00* |
$7,621.50 |
|
DirectAccess+ |
$19,249.05*** |
$4,812.26 |
*25% coinsurance | **Median commercially contracted price | ***ClaimDOC allowable
Plan savings: $11,236.95 | Member savings: $2,809.24
Lafayette, Colorado
A two-day hospital stay for the treatment of coronary artery disease and related procedures.
Hospital bill: $141,450.37
|
Plan |
Patient Responsibility* |
|
|
Traditional Network Plan |
$36,426.23* |
$5,463.93 |
|
DirectAccess+ |
$17,918.98*** |
$2,687.85 |
*15% coinsurance | **Median commercially contracted price | ***ClaimDOC allowable
Plan savings: $18,507.25 | Member savings: $2,776.08
Davenport, Florida
A two-day hospital stay for the treatment of coronary artery disease and related procedures.
Hospital bill: $61,091.48
|
Plan |
Patient Responsibility* |
|
|
Traditional Network Plan |
$22,061.00* |
$4,412.20 |
|
DirectAccess+ |
$11,248.48*** |
$2,249.70 |
*20% coinsurance | **Median commercially contracted price | ***ClaimDOC allowable
Plan savings: $10,812.52 | Member savings: $2,162.50