Sansum Clinic
Decrease (-) Restore Default Increase (+) font size
PrintEmail
Share

 

FacebookIcon.jpg  TwitterIcon.jpg  YouTubeIcon.jpg  InstagramIcon.jpg

 Follow us for healthy tips & info!

Health Plans

California Health Insurance Exchange

Sansum Clinic is pleased to be included in the individual exchange/non-exchange network for Anthem Blue Cross. See our Frequently Asked Questions about Covered CA and other Insurance Exchange Networks. Please visit Anthem Blue Cross or http://www.coveredca.com/ for more information.

Sansum Clinic has established a hotline with information and answers to your questions about the Affordable Care Act (ACA) and Covered California.

Call Our ACA HOTLINE: (805) 898-3301

All other plan types:

 

Health Maintenance Organization (HMO/POS)

IMPORTANT: To obtain HMO coverage for services provided by Sansum Clinic:

  • Your HMO must be contracted with Sansum Clinic; and
  • You must be assigned to either Sansum Clinic or an affiliated independent physician association (i.e. Jackson Medical Group or Santa Barbara Internal Medicine Group); and
  • Your treatment must meet any other requirements set out by the HMO. (For example, medically necessary, provided by your primary care physician or someone he/she refers you to, non-elective, not subject to carve outs, etc. See the Frequently Asked Questions pages for more information on these topics.) 

(back to top)

Preferred Provider organization (PPO)

We contract with these preferred provider organization (PPO) plans. The following list includes most though not all of the PPO plans we can accept. Check directly with your benefit office or the insurer to determine whether your plan allows access to Sansum Clinic, since many plans may have different networks that Sansum Clinic may not be included in per product plan/design.

IMPORTANT: Prior to using our services, always verify with your employer benefits manager or PPO Plan that Sansum Clinic is considered an in-network provider; otherwise, your out-of-pocket costs may be higher or not covered at all if your health plans product/plan design excludes Sansum Clinic as a participating provider.

(back to top)

Exchange/Non-Exchange (narrow) Provider Organization (EPPO) - Individual Plans

Exclusive Provider Organizations (EPO)

Medicare Advantage Plans (HMO, PPO, Pharmacy)

Medicare Advantage Plans - HMO for Individuals - 2015

Medicare Advantage Plans - HMO for Employer Groups/Retirees - 2015

Medicare Advantage Plans - PPO

  • Anthem Medicare Preferred Standard - must live outside Santa Barbara County to sign up with plan - but we are PPO providers for this product.
  • No Medicare Advantage PPO products sold to individuals in Santa Barbara County for 2014, 2015 but an individual or retiree may access care at Sansum Clinic if their plan is on our PPO list.

Pharmacy

Medicare Part D (Prescription Drug Coverage) - 2015

The following are some of the many plans Sansum Prescription Pharmacy may honor. We encourage you to ask one of our pharmacists whether your plan is among the Medicare Part D plans we can accept. Generally, you can change enrollment between October 15th and December 7th of each year, to take effect on January 1st of the following year (low-income seniors may be eligible to change enrollment at any time).

(back to top)

Other Government Plans

We are providers and accept Medicare assignment for:

We are non participating with the government programs below, but we will bill insurance as a courtesy:

Medi-Cal HMO Plans

Sansum Clinic accepts CenCal Health, a Medical HMO only. We do not accept Medi-Cal HMO patients from counties other than Santa Barbara County and San Luis Obispo County

CenCal Health provides coverage at Sansum Clinic for specialty care upon referral (RAF) and a treatment authorization request (TAR) from patient's Assigned Primary Care Physician. We can accept primary care assignment for CenCal Health. Please check directly with CenCal Health to find out if your primary care provider is open to new CenCal patients.

Other Publicly-Funded Health Plans

CenCal Health also administers the following plans that Sansum Clinic provides coverage for as described under Medi-Cal HMO Plans: 

(back to top)

Mental (Behavioral) Health Carveout Plans

See the Frequently Asked Questions  pages for more information about carveouts.

 Workers Compensation Plans

(back to top)

Eyewear and Refraction Plans 

NOTE: Sansum Clinic is not responsible for information in third party websites. For basic guidelines for using health information from the Internet, see our WebGuide section. All plan/network names on this page are the trademarks of the respective companies and are not the property of Sansum Clinic.

(back to top)

 

Related Links
 
© 2014 Sansum Clinic