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.

• Medi-Cal
• Employer Sponsored Group Plans
• CalPERS
• Tricare
• Individual/Covered California Plans

When confirming the status with your health plans, many will ask for our group NPI or Tax ID to look up in their system.

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

Whenever you speak with your health plan, it is beneficial to write down the name and reference number of your conversation for future reference.

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.