Tessa Quinn
Stanford Medicine Children's Health is in-network for all hospital services, all specialist physician services, and Primary Care Physician services at the Monterey location. Stanford HealthCare Alliance uses the Aetna Network pharmacies, and Stanford Children's Health and Lucile Packard Children's Hospital Stanford accept Medi-Cal Fee For Service for all hospital and physician services. Stanford Hospital accepts most major health insurance plans, including Anthem Blue Cross/Blue Shield and Connecticare.
| Characteristics | Values |
|---|---|
| Insurance plans accepted by Stanford Medicine Children's Health | Anthem Blue Cross/Blue Shield (Including Mediblue, CT Health Exchange Plans and a limited number of Empire BCBS plans; excluding BlueCare Prime) |
| Connecticare (Including Medicare, Compass and CT Health Exchange Plans; excluding Individual Value Plan) | |
| Aetna Network | |
| Non-Network pharmacy | |
| Kaiser Permanente Pharmacy | |
| Medi-Cal | |
| Medicare Advantage | |
| Preferred Provider Organization | |
| Exclusive Provider Organization | |
| Health Maintenance Organization |
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What You'll Learn
Stanford Medicine Children's Health Insurance
Stanford Medicine Children's Health is in-network for hospital services, specialist physician services, and Primary Care Physician (PCP) services at their Monterey location. Stanford Children's Health is also in-network for all hospital and physician services under the Medi-Cal Fee For Service plan, which includes the Access for Infants and Mothers Program.
To verify if Stanford Medicine Children's Health is in-network for your specific insurance plan, you can contact your insurance provider directly and provide them with the following information:
- Stanford Medicine Children's Health Physicians Group NPI: 1417907940
- Stanford Medicine 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 note that the Physicians Group NPI and Tax ID are typically needed for outpatient visits, while the Hospital NPI and Tax ID are required for inpatient stays. However, there may be circumstances where both are required, so it is recommended to confirm with your insurance provider.
Additionally, it is important to understand the difference between in-network and out-of-network providers. Preferred Provider Organization (PPO) plans offer a financial incentive to use in-network providers, as they provide higher benefit coverage compared to out-of-network providers. Health care services received from out-of-network providers are typically more expensive and may result in substantial out-of-pocket expenses.
If you have any questions regarding coverage for specific services, it is recommended to refer to your subscriber handbook or contact your insurance provider directly. You can also reach out to the Stanford Medicine Children's Health Financial Counselors for assistance.
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Stanford Hospital's Preferred Provider Organization
Stanford Medicine Children's Health is in-network for all hospital services, all specialist physician services, and Primary Care Physician (PCP) services at their Monterey location. Stanford Medicine Children's Health Physicians and Lucile Packard Children's Hospital Stanford have their own NPI and Tax ID numbers. In general, the Physicians Group NPI and Tax ID are needed for outpatient visits, and the Hospital NPI and Tax ID are needed for inpatient stays.
Stanford Medicine Children's Health accepts a wide range of insurance plans, including:
- Anthem Blue Cross/Blue Shield (including Mediblue, CT Health Exchange Plans and a limited number of Empire BCBS plans; excluding BlueCare Prime)
- Connecticare (including Medicare, Compass and CT Health Exchange Plans; excluding Individual Value Plan)
- Medi-Cal Fee for Service (includes the Access for Infants and Mothers Program)
- Medicare Advantage plans
A Preferred Provider Organization (PPO) is a type of health plan where you pay less to use doctors in the plan's network. Stanford Hospitals Preferred Provider Organization is a network of participating providers, including hospitals and physicians, with which Stanford has contracted. There is a financial incentive to use in-network providers, as they offer higher benefit coverage than out-of-network providers. Patients can typically self-refer to specialists but are responsible for ensuring that all providers are in-network.
Stanford HealthCare Alliance uses the Aetna Network pharmacies, which offer $10 generic, $40 brand name, and $100 non-formulary drugs for up to a 30-day supply.
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Stanford's Medicare Advantage Plans
Stanford Health Care accepts Medicare Advantage plans for all hospital and physician services. Stanford contracts with various Medicare health plan options and offers one Medicare Advantage plan: Kaiser Permanente Senior Advantage.
Medicare Advantage is provided by third-party insurance companies like AARP, Blue Cross, United Health Care, and Health Net. It is an HMO that accepts your Medicare benefits as payment. When you enroll in a Medicare Advantage plan, you assign (or sign over) your Medicare benefits to the HMO. You must go to your HMO provider whenever you need care, and your only out-of-pocket costs are your copayments for the services you receive.
To enroll in a Medicare Advantage plan, you must be signed up for Medicare Parts A and B. You can get information about signing up for Medicare Parts A and B by contacting the Social Security Administration.
If you enroll in the Kaiser Permanente plan, you are not required to choose a primary care physician (PCP). Once Kaiser receives your eligibility, you can contact them to select a PCP. If you enroll in or disenroll from a Medicare Advantage plan, there is an extra form you must complete to alert the plan and Medicare that you are changing the way you've assigned your Medicare benefits.
If you have any questions about your coverage or out-of-pocket costs, you can contact Stanford Health Care's Financial Counseling team by phone at 844-498-2900, Monday through Friday, 8 a.m. to 5 p.m.
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Stanford's Inpatient and Outpatient Care
Stanford Medicine Children's Health is in-network for all hospital services, including inpatient and outpatient care, and all specialist physician services. This means that Stanford hospitals and physicians have contracted with insurance companies to provide services to people enrolled in their health plans.
Inpatient care refers to services provided to patients who are admitted to a hospital for a typically prolonged period. At Stanford, 80% of inpatient care costs are covered by insurance after the deductible for in-network plans, compared to 60% for non-network plans.
Outpatient care refers to services provided to patients who do not require admission to a hospital and can return home after treatment. Routine outpatient care at Stanford is covered at 80% after the deductible for in-network plans, while non-network plans cover 80% of billed charges (up to $300 maximum allowed charges) for professional services only.
Stanford Medicine Children's Health Physicians Group NPI is 1417907940, and the Tax ID is 26-0089066. The Hospital NPI and Tax ID are typically needed for inpatient stays, while the Physicians Group NPI and Tax ID are needed for outpatient visits. However, it is recommended to confirm with your insurance provider whether both the Physicians Group and Hospital Tax ID/NPI are in-network, as some circumstances may dictate using both.
Stanford accepts a wide range of insurance plans, including:
- Anthem Blue Cross/Blue Shield (including Mediblue, CT Health Exchange Plans, and some Empire BCBS plans, excluding BlueCare Prime)
- Connecticare (including Medicare, Compass, and CT Health Exchange Plans, excluding Individual Value Plan)
- Medicare Advantage plans
- PPO plans
- HMO plans
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Stanford's Primary Care Physicians
Stanford Medicine Children's Health is in-network for hospital services, specialist physician services, and Primary Care Physician (PCP) services at their Monterey location. Stanford Children's Health and Lucile Packard Children's Hospital Stanford accept Medi-Cal Fee For Service for all hospital and physician services. Stanford Medicine Children's Health is also in-network for all hospital and specialist physician services.
To be seen at Stanford Medicine Children's Health, your PCP must refer you, and your medical group or health plan must authorize all services requested. Stanford Medicine Children's Health Physicians Group NPI is 1417907940, and the Tax ID is 26-0089066. Stanford Children's Health (Physicians) Tax ID is 26-0089066.
Stanford HealthCare Alliance uses the Aetna Network pharmacies, charging $10 for generic drugs and $40 for brand-name drugs. Stanford accepts most major health insurance plans, including Anthem Blue Cross/Blue Shield and Connecticare.
If you are looking for a Medicare Advantage plan in Stanford, California, there are 30 plans to choose from. Medicare Advantage plans offer additional benefits such as prescription drug coverage, routine dental, vision, hearing, transportation, and reduced cost-sharing. You can sign up for a Medicare Advantage plan through Medicare's website, by speaking to someone from a local SHIP, or directly with an insurance company or broker.
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Frequently asked questions
Stanford Medicine Children's Health is in-network for hospital services, specialist physician services, and Primary Care Physician services. Stanford Hospital accepts a wide range of insurance plans, including: Anthem Blue Cross/Blue Shield, Connecticare, and Medicare Advantage plans.
Medicare Advantage plans are an alternative way to receive your Medicare benefits through private insurance companies approved by Medicare. They offer low or no-cost premiums, additional benefits, and are regulated by the Centers for Medicare & Medicaid Services (CMS).
You can check if Stanford Hospital is in your insurance plan's network by contacting your insurance provider. They may ask for Stanford Hospital's NPI or Tax ID to look up in their system.
A Preferred Provider Organization (PPO) plan is 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 as they offer higher benefit coverage than out-of-network providers.
In-network providers are covered at an in-network benefit level, while out-of-network providers are typically covered at a lower level and are more expensive.
