Insurance Information

What is your insurance?

Please click on any of the following types of insurance to find out more information about Stanford Children’s Health’s status with these plans.

Insurance Information

Will your insurance company cover your / your child’s visit at Stanford Children’s Health?

Coverage for your care at Stanford Children’s Health is determined by your insurance company and is based on the provisions of your specific plan.

We strongly recommend contacting your insurance company directly prior to your visit at Stanford Children’s Health to verify the following:

  • Is Stanford Children’s Health part of your insurance plan’s network (=in-network)?
    Your insurance provider may ask you for Stanford Children’s Health’s group NPI or Tax ID to look up in their system whether we are in-network or out-of-network. Our physicians and hospital each have an NPI and Tax ID number:

    Stanford Children’s Health Physicians Group NPI: 1417907940
    Stanford Children’s Health Physicians Tax ID: 26-0089066
    Lucile Packard Children's Hospital Stanford NPI: 1467442749
    Lucile Packard Children's Hospital Stanford Tax ID: 77-0003859

    Please be aware that if Stanford Children’s Health is out-of-network, you may have a substantial out of pocket responsibility.

    To verify Stanford Children’s Health has in-network status for your plan, you can also look for your plan in the appropriate insurance category below.
  • Is the reason for visit / the procedure why you or your child is being seen at Stanford Children’s Health a covered benefit for your specific insurance plan?
    Health benefit coverage varies with each insurance plan or employer group. Although a Patient Accounts Representative will seek referrals and authorization where necessary, we encourage you to refer to your subscriber handbook, or call your insurance directly with questions regarding coverage for specific services. Please be aware that just because your insurance pre-authorized a visit, it does not automatically guarantee that it is also a covered benefit.

Tip: Whenever you speak with your health plan, it is beneficial to write down the name of the health plan representative you spoke with and reference number (if applicable)  for future reference.  

Should you have any other coverage/benefit questions after speaking with you insurance about an upcoming appointment, please contact our Financial Counselors at (650) 736-2273, 8:00 a.m. – 4:30 p.m.

Have further questions? Email the Managed Care Department at managedcare@stanfordhealthcare.org.

Insurance Glossary

For more glossary terms, please visit to http://www.healthcare.gov/glossary

Preferred Provider Organization: A type of health insurance plan that contracts with medical providers such as hospitals and physicians to create a network of participating providers. There is a financial incentive to use in-network providers by offering higher benefit coverage than out of network providers. Health care services received from providers that are “in-network” are covered at an in-network benefit level, while out of network providers are covered by out of network benefits, which are typically more expensive.  Patients can typically self-refer to specialists, but are responsible themselves for making sure that all providers are in-network.

Exclusive Provider Organization: A type of health insurance plan in which choosing a primary care provider is not required but providers seen must be within the predetermined network.  Out of network care is not covered except in an emergency. Patients can typically self-refer to specialists, but are responsible themselves for making sure that all providers are in-network.

Health Maintenance Organization: A type of health insurance plan in which choosing a primary care provider is not required but providers seen must be within the predetermined network.  Out of network care is not covered except in an emergency. Patients can typically self-refer to specialists, but are responsible themselves for making sure that all providers are in-network.

Deductible: The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

Co-insurance: The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

Out of Pocket Maximum: The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn't include your monthly premiums. It also doesn't include anything you may spend for services your plan doesn't cover.

Referral: A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. If you don’t get a referral first, the plan may not pay for the services.

Authorization: An approval from your health plan for a specific service, usually within a certain window of time. Many plans, including HMOs, require authorizations for all specialist services/procedures.

Primary Care Provider: Health provider that cover a range of prevention, wellness, and treatment for common illnesses. Primary care providers include doctors, nurses, nurse practitioners, and physician assistants. They often maintain long-term relationships with you and advise and treat you on a range of health related issues. They may also coordinate your care with specialists.

Specialist: A physician that focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.