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Billing Information for Insurance Plans

Sansum Clinic automatically provides billing services for our HMO, PPO, and Medicare patients. Insurance coverage may vary depending on the group or plan. Patients are responsible for verifying benefits and coverage.

Review the various Insurance Plans and Healthcare Networks that we accept.  

Out of Area HMO

All patients who have HMO coverage and are assigned to another medical group are referred to as an Out of Area HMO patient. They will be required to make the same financial deposit requirement as a patient without insurance when receiving care at Sansum Clinic. Patients with Out of Area HMO coverage are responsible for filing their insurance claims.

Carve Out Plans

Specific medical services may be covered by a supplemental insurance called a Carve Out Plan. Sansum Clinic may not be contracted with certain plans and the patient may be financially responsible. If a patient has a Carve Out Plan for mental health, eye care, eye wear, or other services not covered under their basic insurance plan, it is important that they verify their coverage prior to making an appointment.

Dual Coverage

Some patients have two active insurance plans. Patients should check specific plans to see if they have coverage for specific services with both policies.

Coverage for Laboratory Services

We partner with Central Coast Pathology and Pacific Diagnostic Laboratories (PDL) for pathology services. It is your responsibility to know whether your insurance covers lab work provided by one of our partners. For more information, please contact your insurance provider.

Open Payments Database

 In accordance with California Assembly Bill No. 1278, starting January 1, 2023, physicians and surgeons are required to provide an Open Payments Database notice to patients at the initial office visit. For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here.

The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made
 available to the public. The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at:

Conforme a la Ley Núm. 1278 de la Asamblea de California, a partir del 1 de enero de 2023, los médicos y cirujanos están obligados a proporcionar un aviso de Base de Datos de Pagos Abiertos a los pacientes en la visita inicial al consultorio. Solo a efectos informativos, se ofrece aquí un enlace a la página web de Pagos Abiertos de los Centros federales de Servicios de Medicare y Medicaid (CMS).

La Ley federal de Transparencia de Pagos a Médicos (Physician Payments Sunshine Act) exige que se ponga a disposición del público información detallada sobre pagos y otros pagos de valor superior a diez dólares ($10) por parte de fabricantes de medicamentos, dispositivos médicos y productos biológicos a médicos y hospitales universitarios. La base de datos de Pagos Abiertos es una herramienta federal utilizada para buscar pagos realizados por compañías farmacéuticas y de dispositivos a médicos y hospitales universitarios. Puede encontrarse en la página: