Stanford Medicine Partners (SMP) contracts with various Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO).
SMP also participates in government programs such as traditional Medicare, traditional Medi-Cal, and TRICARE.
Always check with your health plan to confirm participation.
NPI and Tax ID Information
Although SMP practices go by a variety of names, the billing/insurance entity is called University HealthCare Alliance. Your health plan may not immediately recognize the individual practice name. All SMP practices bill under the following NPI and Tax ID:
- Tax ID: 94-3192446
- NPI: 1760531198
Behavioral Health
- Please be aware that visits with behavioral health professionals will be billed to your behavioral health/mental health insurance carrier.
- Your behavioral health insurance (also called mental health insurance) may be different than your medical insurance which covers your medical treatment.
Understanding behavioral health/mental health insurance benefits:
- Most insurance plans offer medical coverage and behavioral health/mental health coverage, however, they may not always access the same network of providers. Your behavioral health insurance may access a “carve out” network or third-party insurer.
- Your insurance plan network might have different provider or medical facility restrictions for behavioral health versus your medical care.
- As a result of the potential different network restrictions covered by your behavioral health/mental health plan, your insurance plan might cover your medical treatment at Stanford, but not cover behavioral health services at Stanford.
- This could be the case even if your behavioral health issues relate entirely to your medical treatment.
- When you are referred to Stanford behavioral health services, our benefits specialists will determine your behavioral health coverage and associated network of providers and will discuss with you any limitations prior to being scheduled for a New Patient Visit.
What if I don’t have coverage?
- If your behavioral health benefit plan will not allow you to be seen by a member of the behavioral health team, we encourage you to work with our Stanford Health Care social workers and your medical team to seek assistance in selecting a mental health provider who participates in your behavioral health network. You also have the option to seek services at Stanford outside of your behavioral health benefits as a self-payment status for which a patient financial counselor could further assist you in understanding those options.
If you do have behavioral health coverage for services at Stanford Health Care…
- Many patients may require short term behavioral health care during their active treatment period.
- Your specific care may require you to receive services more often, with additional follow up needed over time. We encourage you to take responsibility for understanding your ongoing benefit coverage, for example the number of visits covered for counseling.
- If your insurance company, benefits or network restriction changes and for each new benefit year, it is up to you to continue to make sure your insurance covers services at Stanford.
- Our financial counselors and benefits specialists can help you to understand your insurance coverage as it pertains to seeking behavioral health care services at Stanford.
Contact Us
For assistance choosing a doctor or questions regarding a bill or insurance, call Stanford Health Care Patient Billing at 1-888-924-1036.
The following community practices within Stanford Health Care are known collectively as Stanford Medicine Partners. They bill separately from the rest of Stanford Health Care and insurance plans will identify them as part of SMP. This page includes insurance contracting information exclusively for these practices.
- Alameda Family Physicians
- Alameda Pediatric Associates
- Alliance Medical Group in Pinole
- Alliance Medical Group in San Pablo
- Almaden Family Physicians
- Arthritis and Rheumatology South Bay
- Associated Internal Medicine in San Pablo
- Bay Valley Medical Group in Danville
- Cancer Center in Pleasanton
- Castro Valley Medical Oncology
- Cardiovascular Consultants Medical Group in Castro Valley
- Cardiovascular Consultants Medical Group in Oakland - 9th Street
- Cardiovascular Consultants Medical Group in Oakland - Hawthorne Ave.
- Cardiovascular Consultants Medical Group in San Pablo
- Collaborative Primary Care
- Diablo Valley ENT Pleasanton
- Diablo Valley ENT San Ramon
- Diablo Valley ENT Walnut Creek
- Endocrine Medical Associates
- Express Care Castro Valley
- Family Medicine Associates in Campbell
- Family Medicine Associates in San Jose
- Family Medicine Samaritan Los Gatos
- Los Olivos Women's Medical Group
- Los Olivos Women’s Medical Group Mountain View
- Los Olivos Women’s Medical Group South
- OB/GYN Partners for Health in San Pablo
- Radiation Oncology (Stanford Medicine Cancer Center)
- Samaritan Internal Medicine
- Stanford Gastroenterology Los Gatos
- Stanford Medicine Imaging and Express Care
- Stanford Medicine Partners - Internal Medicine
- Stanford Medicine Partners Castro Valley
- Stanford Medicine Partners Gynecology Emeryville
- Stanford Medicine Partners Gynecology San Pablo
- Stanford Medicine Partners Emeryville Family Medicine
- Stanford Medicine Partners Obstetrics & Gynecology Pleasanton
- Stanford Medicine Partners Pleasanton
- Stanford Medicine Partners Pleasanton 5575 Ste 130
- Stanford Medicine Partners Primary Care Hayward
- University Medical Group Campbell
- Valley Medical Oncology Consultants (Stanford Medicine Cancer Center)
- Tri-Valley Physicians Associates
SMP's Participation in Managed Care Plans for 2023
Aetna
HMO, PPO, POS, and EPO
Anthem Blue Cross
HMO, PPO, and EPO
(SMP is not considered in-network with Anthem Blue Cross Covered California or Cal MediConnect plans)
Blue Shield of California
HMO, PPO, and POS
CIGNA
HMO, PPO, POS & OAP
Health Net
HMO, PPO, POS, & EPO
HealthSmart (formerly Interplan)
PPO, EPO, and POS
Multiplan/PHCS/Beech Street
PPO
Stanford Health Care Alliance (SHCA)
Group Plan
United Health Care
HMO, Medicare Advantage, POS, PPO, & EPO
Stanford Medicine Partners (SMP) participation in Individual/Family Plans for 2024
Have More Questions?
Email the Managed Care Department at managedcare@stanfordhealthcare.org or call the Stanford Health Care Patient Billing Customer Service at 1-888-924-1036.
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.
The percentage of costs of a covered health care service you pay (20%, for example) after you have paid your 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.
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.
A type of health insurance plan that limits coverage to primary care providers and specialists who work for or are contracted with the HMO. You typically must have a referral and authorization for any specialist services. It generally does not cover out of network care except in an emergency.
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 does not include your monthly premiums. It also does not include anything you may spend for services your plan does not cover.
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.
Health provider that covers 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.
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 do not get a referral first, the plan may not pay for the services.
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.
For more glossary terms, please visit Healthcare Glossary.