Stop-Loss, Captives and TPAs

Resolving Claims for Stop-Loss, Captives and TPAs

Best Doctors specializes in finding answers where no one else can. That’s why stop-loss carriers, third party administrators and captives have relied on the expertise of Best Doctors for years to resolve the most complex, chronic and costly claims.

By using powerful analytics and predictive modeling, we identify cases that will benefit the most from an expert medical intervention. Our unique operating model means that Best Doctors is ideally positioned to addresses the main reasons for sub-optimal care and excessive costs:

  • Variations in Physician Quality – Our polling process identifies the experts that other physicians trust most in more than 450 specialties and subspecialties.
  • Location and Access – With the Best Doctors virtual medical review, every claim is reviewed by a top specialist, regardless of where the member resides or the expert works.
  • Identification of Members – We can clinically integrate with other medical vendors, providing referrals between vendors or a fully embedded model for initiating case reviews.
  • Condition-Specific Programs – Based on claim cost and frequency, Best Doctors has created specialty programs (called “virtual centers of excellence”) to address high-cost conditions like cancer, musculoskeletal disorders and others.
  • Engagement of Members – Programs can include training and clinical integration referrals between medical vendors or a fully embedded model for initiating case reviews.


The Best Doctors services seamlessly integrate with existing programs and ultimately reduce the severity of serious claims and assisting with faster return to work. We see an average cost savings of roughly $36,000 for cases where we perform a detailed case review, but approximately $116,000 in savings for critical care cases—those involving severe accidents, traumatic injuries, infections, etc.

Simply put: we help move cases forward, toward faster resolutions and optimal outcomes.