Sansum Clinic: For Your Good Health

Insurance Plans Sansum Clinic Accepts

We accept Medicare, Medicare Advantage Plans, Medicare Part D, CenCal Health Plans, HMO, PPO's, Mental (Behavioral) Health Plans, and Workers Compensation Plans. At each visit, you should:

  • bring picture identification and any insurance cards,
  • stop at the Registration desk,
  • update your registration information,
  • pay your co-payment or coinsurance at that time, and
  • provide insurance information from your health plan ID card

It is imperative that you also provide updated information to Sansum Clinic whenever:

  • You receive a new insurance identification card
  • You are assigned to another provider group (HMO)
  • You select a new primary care physician (PCP)
  • Your address, name, or phone number changes

Insurance plan coverages and contracts are always subject to change. So it's important that you get confirmation of plan details directly from the insurance company before making a decision.

Plan Types

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 and Glossary pages for more information on these topics.)

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.

Medicare Advantage Plans

Medicare Advantage Plans — HMO

Medicare Advantage Plans — Private Fee for Service (PFFS)

Medicare Advantage Plans — Regional PPO

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).

Free and comprehensive resources are available to help your family learn more about Medicare Part D prescription drug coverage. For information, or assistance selecting a plan that's right for you, we recommend:

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.

Medi-Cal 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.

Mental (Behavioral) Health Carveout Plans

(See the Frequently Asked Questions and Glossary pages for more information about carveouts.)

Worker Compensation 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.

For years we've been bringing world-class physicians to Santa Barbara County. Sansum Clinic is here …for your good health A 501(c)(3) California nonprofit public benefit corporation.

© 2008 Sansum Clinic. All rights reserved. Usage is subject to the terms of service.