Understanding the Billing Process

At Sansum Clinic, we work to make the billing process streamlined for our patients.

Step 1: When you come to us for a service, we will ask you for your health insurance card and other information.

Step 2: You will be asked to pay for your portion of the estimated bill at the time of service.

Step 3: After your service, we will contact your insurance company to collect the portion they will owe. Sometimes your insurance company will not pay right away because they require more information. This might slow down payment on your account.

Step 4: If a claim is denied because the insurance company does not have enough information, we will work with you and your insurance company to get the missing information. In some cases, there is a secondary insurer, and we will work with them as well. If services are responsibility of a third party payer please contact our Customer Service department.

Step 5: Once all insurance payments are received, we may ask you for additional payments for the amount not yet paid. The amount due can be a non covered service, deductible, copays or co-insurance. If you have an amount due that you feel is in excess of what you should owe, first compare it to your explanation of benefits from your health insurance. If the amount is the same please contact your health insurance company for an explanation. If you are uninsured, you may be eligible to receive a discount from your total charges, with the exception of any same day self-pay price.

We understand that at times you may be unable to pay your medical bills in full. For that reason, Sansum Clinic has established monthly payment arrangements. If you have questions please contact our Customer Service Department to speak with one of our agents:
(805) 681-1780
billing@sansumclinic.org

Account Statements and Contact Attempts

You will receive a series of written notices for your bills in the following order:

An initial billing statement will be sent to you once your insurance has responded. The initial billing will include a summary of your charges after each service so you will see actual charges made to your account by date of service. After that you will only receive your one monthly guarantor billing statement with the amount you are responsible to pay.
There will be four attempts to contact you. These contacts will occur over a 120-day period from the first attempt to contact you. You will always have the ability to ask us for an itemized statement or contact a customer service department about your bill. If you have not submitted payment or made payment arrangements with us after the four written notices, we will send your account to a collection agency. Additionally, your account will be sent to a collection agency if you indicate at any time that you will not pay

your bill or the written notices are returned due to an invalid address.

Payment Policy

We work hard with every patient to arrange payment for care. However, even if you have a modest income, we expect everyone to contribute something to the cost of his or her care.

If you do not pay what you owe for your services, you eventually will be turned over to a collection agency but only after several billing notices and attempts to contact you. We are always willing to work with patients who make reasonable efforts to pay for their care.

What should I do if I cannot pay my bill in full when received?
You can contact one of our Customer Service agents at 805-681-1760 and they can assist you with setting up a payment plan.

How can I make a payment?

By Phone: You can call our Customer Service Department and make a payment over the phone to one our customer service agents. Call 805-681-1760 or 1-800-281-0284.

By Mail: You can mail in your check or credit card payment to the address noted on the top portion of your statement or in the enclosed envelope to: P. O. Box 101033, Pasadena, CA 91189-1033

Keywords to help you better understand the billing process:

Adjustment: When your balance due has changed either up or down, both the insurance company and the clinic could adjust your balance.

Charge: The initial amount that a clinic gives to each service before a patient has the service.

Claim: A form submitted to the insurance company for payment.

Coinsurance: A percentage of eligible expenses that you must pay. Co-insurance usually applies after you meet your deductible.

Coordination of Benefits: Determining which insurance company pays first if you are covered under more than one insurance plan.

CoPay: When you pay a specific amount for a service, a copay is due at the time of service.

Cost: The amount a patient will pay after services have been completed and insurance has been applied to the amount.

Covered Services: Specific services or supplies that your insurance reimburses.

Deductible: The agreed amount of money your benefit plan requires you to pay first before they will pay. The deductible is usually an annual amount. After the deductible has been met, you will pay any eligible expenses for the rest of the year.

Dependent: The person you carry on your insurance. Often this is a husband, wife or child.

Disallowed Amount: The difference between total on the bill and the amount your insurance company covers.

Group Number: A health plan ID number usually found on your insurance card.

Guarantor: The person responsible for paying the bill.

Health Insurance Exchange: The place to get insurance in California if you currently do not have any.

In Network: Doctors or hospitals participating in your health plan or insurance plan.

Insured: A person who has insurance.

Itemized Statement: A list of all items and services during your stay.

Medicaid: Health insurance for low or modest-income individuals.

Medicare: Health insurance for individuals 65+ and persons with disabilities.

Non-Covered: Services that are not covered by a patient’s insurance plan.

Out of Network: Doctors and hospitals NOT on the "preferred" list for your insurance plan.

Out of Pocket Maximum: The maximum amount a person needs to pay themselves.

Patient Responsibility: The amount the patient is expected to pay.

Preauthorization/Precertification: Getting advance approval from your insurance company for your services.

Price: The amount after services have been completed without insurance applied.

Primary Care Provider: Your doctor who coordinates your care.

Primary Insurance: The insurance company with first responsibility for paying eligible health expenses.

Provider: A healthcare professional (doctor or nurse practitioner) or facility (such as a hospital or clinic).

Secondary Insurance: The insurance company with second responsibility for paying eligible health expenses.

Subscriber: The person who purchased the insurance.