Tying It All Together

Health Fee versus Health Insurance - Which Do I Use?

The chart below is intended to show examples of services offered at Vaden Health Center that are covered under the Health Fee versus services offered at Vaden Health Center that are not covered under the Health Fee. Many of the services listed that are not covered under the Health Fee are covered routinely by insurance plans, but students with alternative insurance should seek insurance-covered care according to the terms of their plan in order for it to be covered. For the services not covered under the Health Fee, students may be asked to show their insurance card, or, if not enrolled in Cardinal Care, may be asked to make payment up front and seek reimbursement from their alternative plan.

Services covered under the Health Fee

Primary Care Medical Services

Medical appointments during weekday hours (with web-based booking capability)
Some weekend hours (see the Vaden Health Center website at vaden.stanford.edu for services offered)
24-hour telephone medical advice for urgent conditions
Medical care management
Confidential web-based messaging with clinicians

Counseling and Psychological Services (CAPS)

Counseling assessments and short-term therapy
24-hour crisis counseling services (after-hours crisis support by phone)
Care management and referral services
Groups and workshops that focus on a range of mental health and well-being needs for students

Well-Being Services

Nutrition counseling and education

Services offered at Vaden Health Center but not covered under the Health Fee*

Pharmacy prescriptions and other medications
Physical Therapy treatment
Travel Clinic visits and travel-related vaccinations
Immunization and Injection Clinic Services (including immunizations and tests to meet the university’s Health Requirements if needed)
Laboratory testing (Most specimens collected at Vaden Health Center are sent to Quest Diagnostics, Inc. for testing.)
Professional interpretation of diagnostic radiology images (X-rays taken at Vaden Health Center will be read by a Stanford Health Care or community radiologist.)
Ongoing individual therapy sessions at CAPS which exceed a brief treatment model (providers will discuss any applicable fees with students before billing occurs)
Psychiatric medication evaluation and management
Physical examinations (and associated lab tests and x-rays) for employment, special programs, or other purposes
Medical specialty consultations (those offered at Vaden Health Center currently include Optometry and Disordered Eating Care)

*Pharmacy, Physical Therapy, and specialist services will be billed to insurance, whether it is Cardinal Care or an alternative plan. Vaden will bill Cardinal Care for other services that are not covered under the Health Fee, but does not bill alternative insurances. If you have alternative insurance, you may be required to pay up front and seek reimbursement from your alternative plan for these services.

Health Fee versus Health Insurance - Learn How They Fit Together

From the previous table, it’s apparent that Vaden Health Center offers a mix of services covered by the Health Fee as well as services not covered by the Health Fee (which may, or may not, be covered by health insurance). Below are some examples of services that can be confusing to navigate and explanations of how they work.

Specialty Care at Vaden

When students need specialty medical care, the Vaden Health Center providers may refer to specialists outside of Vaden Health Center; to Stanford Health Care, Menlo Medical Clinic, Sutter Health or other local options. Services provided by these entities are not covered under the Health Fee; they will be charged to the student’s health insurance (which is why it is so important that students have health insurance that is in network for the affiliated providers of Stanford University Medical Center, Sutter Health, or other local health care systems).

However, for a select few specialties that are more relevant to our student population, such as Optometry and Disordered Eating, specialists actually come to Vaden Health Center to provide care. (Space is made available at the Vaden Health Center site as a convenience to students.) Even though this specialty care is provided at Vaden Health Center, it is not covered under the Health Fee. These Stanford Medicine specialists will bill their services to the student’s health insurance, and copays and deductibles will most likely apply. Students who have coverage through an alternative health insurance plan can also see these specialists in the Vaden Health Center setting but should make sure that the terms of their plan allow them to do so. For example, a student with health insurance through Kaiser Permanente would need to have care through a Kaiser specialist in order for it to be covered by the Kaiser plan. If this student decides to have specialty care at Stanford Health Care, Menlo Medical Clinic OR Vaden Health Center instead of at Kaiser, the out-of-pocket cost to the student may be for the full amount of the service provided.

Laboratory Services at Vaden

Vaden Health Center has a laboratory on site where blood and other specimens are collected and processed. If a Vaden Health Center clinician orders labs as part of a student’s care, the student can use the on-site laboratory to have blood drawn or urine collected, for example. This collection of the specimen, if performed at Vaden Health Center, is covered under the Health Fee. Once the specimen has been collected, with a few exceptions, Vaden Health Center will send it out to a reference laboratory, typically Quest Diagnostics, Inc., or Stanford Health Care, for analysis. In most instances, the analysis/ testing of the specimen that is performed by Quest Diagnostics, Inc., or Stanford Health Care is billed to the student’s insurance. For students enrolled in Cardinal Care, lab testing is covered at 100% after the deductible has been met. For students who have coverage through an alternative health insurance plan, it’s a good idea to make sure that Quest Diagnostics, Inc. and/or Stanford Health Care are in network and what the terms of coverage for laboratory services are.

Radiology Services – Plan Year

Vaden Health Center houses a radiology suite on-site where digital x-rays are taken. If a Vaden Health Center clinician orders an x-ray as part of a student’s care, the student can, in many instances, have the image(s) made at Vaden Health Center. The taking of the x-ray and its processing, if performed at Vaden Health Center, is covered under the Health Fee. Once the image(s) has been taken, Vaden Health Center will transmit it (or them) to Stanford Health Care to be read by a radiologist. The analysis that is performed by the Stanford Health Care radiologist is billed to the student’s insurance. For students enrolled in Cardinal Care, the analysis of images is covered at 100%. Students who have coverage through an alternative health insurance plan should make sure that Stanford Health Care is in network and should understand what the terms of coverage for diagnostic interpretation of x-rays are. Important to note—Vaden Health Center does not offer complex radiology services (such as MRI or ultrasound). Students who need complex radiology services will be referred to a community provider.

Radiology Services – Summer Quarter

Vaden Health Center does not offer radiology services over the summer, typically from July 1 and continuing through Labor Day in September. During this period, students who come to Vaden Health Center and need radiology services are referred to a community provider. The student’s health insurance will be billed for radiology services provided.

Health Fee versus Health Insurance - When Insurance Matters Most

While it would be great if Vaden Health Center could meet all of your health care needs during your time at Stanford through services covered under the Health Fee, the reality is you could need care that the health center can not or does not provide. For these scenarios, some of which are listed below, you will need to use your health insurance.

Emergency care
Inpatient care/hospitalization
Mental health services or substance use care requiring inpatient treatment in a hospital or residential facility
Long-term mental health therapy
Outpatient specialty care
Diagnostic testing
Care while you are away from campus, such as when traveling
Care when Vaden Health Center is closed

We know that these scenarios will be covered under Cardinal Care, as long as the terms of the plan are followed, but what we don’t know is whether your alternative insurance will provide coverage (or if it does, how good that coverage will be). The Vaden Health Center staff, especially the professionals in the Insurance and Referral Office, are able help you navigate care you may receive using Cardinal Care benefits, but they won’t be knowledgeable about alternative health insurance plan benefits.

Consider for a moment, a scenario in which a student is unexpectedly diagnosed with an illness or condition that requires a short hospital stay. If this student has Cardinal Care, the needed treatment could, most likely, occur at Stanford Health Care or Sutter Health, in a hospital right on the Stanford campus. If this student has chosen an alternative health plan, and Stanford Health Care or Sutter Health is not in network, the student may need to go home to get care, in order for the services to be covered. What might be a short interruption to studies in the first situation, could be a much longer disruption in the second.

Or, consider a less acute example, in which a student needs ongoing specialty support for a chronic medical or mental health condition, but whose alternative health insurance plan does not cover needed services in the immediate Stanford area. This student might be forced to travel a significant distance to obtain care that is covered by insurance, which could impact time spent on studies and other activities and incur travel costs.

Scenarios such as these are why we strongly advocate that alternative health insurance plans need to cover care in the Stanford vicinity.