Audit Reduces Member's Cost by $9K, Saves Plan Nearly $31K

Audit Cases Apr 24, 2026

Audit Reduces Member’s Cost by $9K, Saves Plan Nearly $31K

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. Using Turquoise Health to find the median commercially contracted price, we can show 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.

Jacksonville, Florida

A one-day hospital stay for the treatment of coronary artery stent stenosis and related procedure.

Hospital bill: $105,748.72

	Plan	Patient Responsibility*
Traditional Network Plan	$59,641.24**	$17,892.37
DirectAccess+	$28,801.09***	$8,640.33

*30% coinsurance | **Median commercially contracted price | ***ClaimDOC allowable

Plan savings: $30,840.15 | Member savings: $9,252.04

Aurora, Colorado

A four-day hospital stay for the treatment of acute respiratory failure and acute bronchiolitis due to respiratory syncytial virus (RSV).

Hospital bill: $50,060.92

	Plan	Patient Responsibility*
Traditional Network Plan	$31,384.24**	$6,276.85
DirectAccess+	$13,008.75***	$2,601.75

*20% coinsurance | **Median commercially contracted price | ***ClaimDOC allowable

Plan savings: $18,375.49 | Member savings: $3,675.10

Tallahassee, Florida

A five-day hospital stay for the treatment of diabetes-related chronic right foot ulcer and related surgery.

Hospital bill: $145,262.38

	Plan	Patient Responsibility*
Traditional Network Plan	$44,419.31*	$13,325.79
DirectAccess+	$22,332.98***	$6,699.89

*30% coinsurance | **Median commercially contracted price | ***ClaimDOC allowable

Plan savings: $22,086.33 | Member savings: $6,625.90

Lodi, California

A four-day hospital stay for the treatment of urinary tract infection, abdominal pain, acute diastolic heart failure and pneumonia.

Hospital bill: $111,717.24

	Plan	Patient Responsibility*
Traditional Network Plan	$33,347.44*	$6,669.49
DirectAccess+	$15,154.68***	$3,030.94

*20% coinsurance | **Median commercially contracted price | ***ClaimDOC allowable

Plan savings: $18,192.76 | Member savings: $3,638.55

Boise, Idaho

A two-day hospital stay or the treatment of artery disorder with related surgery.

Hospital bill: $59,213.18

	Plan	Patient Responsibility*
Traditional Network Plan	$34,618.66*	$8,654.66
DirectAccess+	$19,474.69***	$4,868.67

*25% coinsurance | **Median commercially contracted price | ***ClaimDOC allowable

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