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Health Insurance Plans
Stanford Health Care (SHC) contracts with various Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO).
SHC participates in government programs such as Medicare, Medi-Cal, and TriCare.
For enrollment questions about Covered California please
visit their website or call
1-800-300-1506.
Insurance Inquiries and Pre-Authorization
The Patient Financial Clearance team is available to answer your questions related to insurance and pre-authorization before a procedure. Please contact us with your questions.
PATIENT FINANCIAL CLEARANCE
Phone: 650-724-4445
Toll Free: 1-877-291-7335
Monday – Friday, 8:00 a.m. – 5 p.m.
Always check with your health plan to confirm participation. For assistance choosing a physician, please call the Stanford Consumer Referral line at 1-800-756-9000. Click the health plan name below to visit their website.
Active for Calendar Year 2016 (Group Plans)
Aetna
HMO (referral only), PPO, POS & EPO
Anthem Blue Cross
HMO (referral only), PPO & EPO,
except Blue Cross
Medi-cal HMO
Blue Shield
of California
HMO (referral only), PPO, & POS
CIGNA
*HMO, PPO, POS & OAP
Health Net
HMO (referral only), PPO, POS & EPO,
except HealthNet Medi-cal
HealthSmart
(formerly Interplan)
PPO, EPO & POS
Multiplan/PHCS/Beech Street
PPO
United Health
Care
HMO (referral only), POS, PPO & EPO
*Cigna HMO members may choose to select Stanford Health Care physicians as their primary care physician (PCP).
Individual and Covered California Plans Active for Calendar Year 2016
We are contracted and in-network with the following individual plans available for purchase directly from health plans or through the Covered California Exchange
Anthem Blue Cross
PPO, EPO, and
HMO: Hospital services only, all physician services are out of network.
Cigna (Not available for
purchase through Covered California)
PPO: Includes hospital and physician services in-network.
Health Net
PPO,
EPO, and HMO/HSP: Includes hospital and physician services
in-network.
United Health
Care
PPO and EPO: Hospital services only, all
physician services are out of network.
Valley Health
HMO: Includes hospital and physician services in-network for
specialty services only.
Please contact your health plan directly to confirm your eligibility
If you have any questions please contact the Managed Care Department at 650-724-1460 or at managedcare@stanfordhealthcare.org.
During high volume call times during the year, such as the Open Enrollment period, it is advised to email your question, as it will be answered more quickly.
Other helpful Web sites for information on health insurance and managed care are:
Health insurance glossary
EPO (Exclusive Provider Network)
A type of health insurance plan that, like an HMO, limits health coverage to doctors and hospitals within the network. However, EPOs also provide options for patients to see specialists outside of the network.
HMO (Health Maintenance Organization)
A type of health insurance plan that limits health coverage to doctors and specialists who work for the organization. HMOs provide an integrated approach to health care, often with an emphasis on prevention.
OAP (Open Access Point of Service Plan)
A type of flexible health insurance plan that offers in-network referrals from your primary care doctor, as with an HMO. Additionally, patients can self-refer to specialists and facilisties within the network at a discount, or receive care at out-of-network prvoiders at a higher cost.
POS (Point of Service)
A type of of health insurance plan that charges less if you use doctors, hospitals, or providers within the plan's network. These plans require a referral from your primary care doctor to see a medical specialist.
PPO (Preferred Provider Organization)
A type of health insurance plan consisting of a network of hospitals and doctors. Health care received outside of the network can be covered at an additional cost.