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Stanford Hospital & Clinics and Lucile Packard Children's Hospital use several billing methods. The billing method used for a patient's bill is determined by insurance type.
Please select one of the following patient billing statements:
Term Definitions
Primary Insurance
Managed Care
Medicare
Medi-Cal
Share of Cost (SOC)
California Children Services (CCS)
Secondary Insurance
Self-Payment or Self-Pay
Worker Compensation
Primary InsuranceThe first insurance to be billed according to industry rules and the terms and conditions of your insurance plan.
- Stanford Hospital & Clinics and Lucile Packard Children's Hospital bill the patient's primary insurance carrier for all services. The primary insurance carrier will typically make payment to Stanford Medicine in accordance to your benefit plan.
- The billing office will submit bills to the patient's insurance plan if the patient has supplied us with current and correct information. Our policy is to allow the insurance carrier 60 days to pay a claim. If a payment has not been received from an insurance carrier within 60 days we may request the patient's assistance in working with the insurance carrier for payment.
- The insurance carrier is a contract between you, your employer and your insurance company. It is in your best interest to know and understand your plan benefits, as well as any deductible and co-payment amounts that you are responsible for paying.
- Insurance payments vary depending on what type of insurance you have and how the payer determines payment. Some plans pay at a contracted rate, some plans will look at the range of fees within the community and some plans will pay on a predetermined fee schedule regardless of the amount charged.
- Not all services are covered in all insurance contracts. If your insurance plan does not cover a service or procedure, you are responsible for these charges.
Managed Care
- Refers to a variety of approaches to managing health care, from a standard indemnity plan to health maintenance organizations.
- The focus of managed care is usually on controlling health care costs. This is accomplished in a number of ways, including contracts with specific providers, incentives to those providers to keep costs down and a review process to prevent the use of unnecessary health services.
Medicare
- If you are a Medicare patient, Stanford Hospital & Clinics will prepare and submit your claims to Medicare on your behalf.
- Stanford Hospital & Clinics accepts Medicare assignment of benefits; this means that Stanford Hospital & Clincs will accept the amount that Medicare allows.
- After Medicare payes their portion of what they allow, Stanford Hospital & Clinics will bill your supplemental insurance directly for the remaining balance, including Medicare deductibles and copayment amounts.
- If you do not have supplemental insurance you will be responsible for payment of the balance, after Medicare pays, within thirty (30) days of our billing to you.
- Medicare patients may call the following phone numbers for assistance:
- Part A: (866) 380-4745 - Administered by United Government Service
- Part B: (800) 952-8627 - Administered by National Heritage Insurance Company
- HICAP: (800) 200-0268 - Health Insurance Counseling & Advocacy Program
Medi-Cal
- Medi-Cal is California's Medicaid program
- Medi-Cal provides health services through a federal and state medical assistance program for categorically eligible and low-income persons. Eligibility determination is conducted through Local County Welfare Departments.
- If you are covered under the CA State Medi-Cal Program, you are required to provide eligibility card or proof of eligibility for each month of service.
Share of Cost (SOC)The amount a beneficiary must pay toward their health care costs before Medi-Cal will pay. The SOC may change when monthly income changes.
California Children Services (CCS)The California Children Services (CCS) Program provides diagnostic and treatment services, medical case management, physical and occupational therapy services to children under the age of 21 years with CCS-eligible conditions. Please provide an authorization from CCS.
Secondary InsuranceSecondary insurance is the second insurance to be billed according to industry rules and the terms and conditions of your insurance plan. After your primary insurance has processed your claim, coordination of benefit rules generally apply which are a method of integrating benefits payable under more than one health insurance plan so the insurance benefits from all sources do not exceed 100% of allowable medical expense. If a patient has dual coverage, we will file a claim for service with the secondary insurance.
Self-Payment or Self-Pay
If you do not have insurance, or if you are seeking care at Stanford Hospital & Clinics and Lucile Packard Children's Hospital outside of your insurance plan benefits, you are considered a self-pay patient. The Stanford Hospital & Clinics and Lucile Packard Children's Hospital self-pay policy requires full payment within 30 days of billing.
Worker CompensationWorker Compensation provides insurance-type coverage for work-related illnesses and accidents. In order to use this insurance you must provide the appropriate insurance information, employer information, claim number and date of injury.
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