The DOC

SEP 2020 | Get the latest from the best RBP advocates and auditors 

Industry Perspective

Andy Orear

Vice President of Distribution

Renewal Season is Upon Us

If you think you will flatten renewals this year, you should reconsider. While it is true COVID-19 held utilization down to levels unseen for almost a decade, stop-loss carriers and fully insured carriers are always planning. Premiums are collected in anticipation of future losses, and while the aggregate policies were all major winners this year, the specific contracts in 2021 are going to need a boost to cover the larger than typical losses expected due to members having care postponed due to COVID-19. Perhaps members have even delayed care themselves regarding known conditions and ailments. Read more..

Client Savings

Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.

1. Cleveland, OH

Six-day hospital stay for treatment of convulsions 

High-Dollar Services:

EEGs: $53,444

ICU Room and Board: $20,376

Savings Summary:

Billed Charges: $79,365.15
ClaimDOC Allowed: $9,813.01
Plan Savings: $69,552.14
Reduction: 88%

2. Fairfield, CA

Three-day hospital stay for delivery of newborn by c-section

High-Dollar Services:

Operating Room: $41,996.41

Room and Board: $17,711.88

Pharmacy: $13,633.30

Savings Summary:

Billed Charges: $96,684.88
ClaimDOC Allowed: $12,064.66
Plan Savings: $84,620.22
Reduction: 87%

Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer 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.

Member Experience

Feedback from a Member

Thank you! I am saying that with such a huge sense of relief. Before moving to ClaimDOC, health insurance was a stressful part of my life for far too long. When Karen, my ClaimDOC Member Advocate, said she would handle my balance bill, I hoped that I would not have to scrutinize the details. When I opened her email yesterday, I was overcome with relief. Karen made my hopes a reality. Thank you, ClaimDOC, for the service you provide. Your conscientious work and persistent effort is appreciated.

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