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Health Maintenance Organization (HMO)
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.)
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Preferred Provider organization (PPO)
We accept many 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 covers treatment at Sansum Clinic, since many plans (especially those that are self-funded) may participate in one of the networks below.
IMPORTANT: Prior to using our services, always verify with your employer benefits manager or PPO that we are one of the plan's authorized providers; otherwise, your out-of-pocket costs may be higher.
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Medicare Advantage Plans (HMO, PPO, Pharmacy, Resources)
Medicare Advantage Plans - HMO
Medicare Advantage Plans - HMO for Employer Groups
Medicare Advantage Plans - Regional PPO
Pharmacy
Medicare Part D (Prescription Drug Coverage)
The following is a sampling of some of the many plans Sansum Prescription Pharmacy can honor. If your Medicare Part D plan is not among those mentioned below, we encourage you to ask one of our pharmacists whether your plan is among the many other Medicare Part D plans we can accept. Generally, you can change enrollment between November 15th and December 31st 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).
- AARP Medicare Rx; Preferred, Advanced and Enhanced
- Aetna Medicare Rx; Premier, and Essentials
- Aetna CVS/pharmacy Prescription Drug Plan
- Blue Cross Medicare Rx; Plus, Gold, and Standard
- Blue Shield Medicare Rx - Basic & Enhanced & Premium Plan
- BravoRx
- Cigna Medicare Rx Plan; One
- Community CCRx; Basic, and Choice
- CVS Caremark; Plus, and Value
- Envision Rx; Silver, and RxPlus Gold
- First Health Part D; Premier, ValuePlus & Premier Plus
- HealthNet Orange; Option One, and Option Two
- HealthSpring Prescription Drug Plan - Reg. 32
- Humana; Complete & Enhanced
- Humana Walmart - Preferred Rx Plan
- Medco Medicare Prescription Plan, Value Plan & Choice Plan
- Rite Aid Envision Rx Plus
- WellCare; Signature, and Classic
- United American; Preferred & Select
Resources
Free and comprehensive resources are available to help your family learn more about Medicare Part A, B, C, & D. For information, or assistance selecting a plan that's right for you, we recommend:
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Other Government Plans
Although we do not have a contract with the following government programs, we do participate and accept their non-contracted rates, and with Medicare, we accept par rates.
MediCal HMO Plans
CenCal Health provides coverage at Sansum Clinic for some specialty and limited pediatric 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.
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:
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Mental (Behavioral) Health Carveout
See the Frequently Asked Questions pages for more information about carveouts.
Workers Compensation
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Eyewear and Refractions
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.
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