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.
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. https://openpaymentsdata.cms.gov.
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.