Sansum Clinic: For Your Good Health

Frequently Asked Questions (FAQ)

Topics

Services

Is Sansum Clinic a hospital?
No. Sansum Clinic is a nonprofit medical foundation providing advanced technology and a quality environment for the best possible practice of medicine. We contract with over 140 staff physicians practicing more than 30 specialties at our multi-specialty clinics and specialty clinics from Carpinteria to Lompoc. We have several local hospital affiliates, however.
Is Sansum Clinic an HMO, PPO, or insurance plan?
No. Sansum Clinic is a nonprofit medical foundation providing advanced technology and a quality environment for the best possible practice of medicine. We contract with over 140 staff physicians practicing more than 30 specialties at our multi-specialty clinics and specialty clinics from Carpinteria to Lompoc. We do accept many health insurance plans, including both HMOs and PPOs.
Do I need to "join" or become a "member" of Sansum Clinic in order to get treatment?
No. Anyone can make an appointment to see our primary care providers. However, HMO insurance plans typically require that their subscribers either be assigned to Sansum Clinic, or else obtain a written referral from their assigned medical group, before seeking treatment from Sansum Clinic specialty care providers; so it is important to check with your insurance plan about their specific requirements, if any.
What is the difference between Sansum Clinic, Sansum Medical Research Institute, and Sansum Medical Research Foundation?
Although Sansum Clinic has a founder/namesake in common with Sansum Medical Research Institute (formerly Sansum Medical Research Foundation), the two organizations are separate and unaffiliated businesses.
My doctor says that I need to see a specialist; does Sansum Clinic have specialists practicing in that field?
In all likelihood, we do. Our providers practice more than 30 medical specialties at locations throughout Santa Barbara County. There are several easy options for identifying a provider who is right for you:
  • Use our Find A Provider feature to search for the providers practicing that specialty, then click on a provider's name to learn more about their professional qualifications, interests, and location.
  • Browse our list of Departments, to learn more about both the medical specialty itself as well as how our providers can help you.
  • Enter a related term in our Site Search box to find the articles, news, research, providers, departments, specialty services, events, and locations which are related to that topic.
How are medical decisions reached?
As a non-profit public benefit organization, our mission focuses on health, not profit. Maintaining good community health is what guides us; achieving that goal is what each of us takes pride in. That's why you can be assured that at Sansum Clinic our providers receive no incentives for denying coverage or care. Our staff of health care professionals relies on medical criteria such as medical necessity, health benefit, availability, safety, and effectiveness to reach decisions regarding your health care. The team at our Managed Care Referrals Department considers factors such as appropriateness of care and service, as well as your existence of coverage. Our doctors collaborate with you to identify options which best meet your needs. Good judgment and good health are what it's all about.

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Visiting/Locations

Which Sansum Clinic location is nearest to me? Is it necessary to drive into Santa Barbara to get treatment?
With locations from Lompoc to Carpinteria, you can obtain Sansum Clinic high-quality health care where it is most convenient for you.
What are Sansum Clinic's hours of operation?
Hours of operation vary between locations and their individual offices. To display hours of operation, click on a location's name within our locations directory, then click on its "Phone/Fax/Hours" button.
Can you give me driving directions to this Sansum Clinic location?
Yes. Our locations directory makes it easy to view maps and get driving directions between your home/office and the Sansum Clinic site of your choice. Just click on a location's name, then click on its "Directions" button.
I am coming from out of town. Can Sansum Clinic help me locate accommodations?
Yes. We maintain special arrangements with a selection of local hotels, motels, and transportation services to ensure that our patients can receive preferred rates at quality accommodations. Additionally, the Night Before Service may be an option for patients whose surgery is scheduled for early-morning.

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Choosing A Provider

What is the difference between "primary care" and "specialty care"?
Some insurance plans require patients to obtain written referral from a primary care physician before seeking treatment from a specialty care provider; so it is important to check with your insurance plan about their specific requirements, if any. Primary care physicians are available at all of our multi-specialty clinics plus most of our specialty care clinics. Our primary care fields include:

In addition to primary care, our clinics also provide specialty care in a wide range of medical fields. Please see our Specialties section and for a complete list.

I already have a primary care doctor. Can she or he refer me to Sansum Clinic for treatment?
Yes. Any primary care physician, whether affiliated with us or not, can refer you to Sansum Clinic. Note, however, that your insurance plan might have additional restrictions (see "Do I need to join..." above).
I do not yet have a primary care physician (PCP). Do I need one? How do I choose a Sansum Clinic primary care physician?
HMO plans require their subscribers to select a primary care physician (PCP); for all other patients, we encourage you to select a PCP, but it is not required.
What is the difference between a "physician provider" and "non-physician provider"?
Health care services are provided by a variety of highly-trained, licensed medical professionals. The most recognizable type are known as "physician providers"; these providers include:
  • Medical Doctors (MD)
  • Doctors of Osteopathic Medicine (DO)
Many health care services are carried out by "non-physician providers" as well. These are typically supervised by, or in collaboration, with a physician. Non-physician providers include:
  • Audiologists
  • Certified Nurse Midwifes (CNM)
  • Certified Registered Nurse Anesthetists (CRNA)
  • Clinical Nurse Specialists (CNS)
  • Doctors of Optometry (OD)
  • Doctors of Philosophy (PhD)
  • Licensed Clinical Social Workers (LCSW)
  • Marriage & Family Therapists (MFT)
  • Occupational Therapists (OT or OTR)
  • Nurse Practitioners (NP), including Family Nurse Practitioners (FNP), Pediatric Nurse Practitioners (PNP), and Certified Pediatric Nurse Practitioners (CPNP)
  • Physician Assistants (PA or PA-C)
  • Physical Therapists (PT or PTA)
  • Registered Nurses (RN or RNC)
  • Registered Nutritionists (RD)
Physicians are usually better-equipped to manage more complicated cases, while non-physician providers are frequently excellent sources of routine care. The quality of care you receive always meets the same high standards, regardless of whether you are being treated by a physician provider or a non-physician provider. While physicians alone are responsible for certain activities such as prescribing controlled drugs and performing surgeries, other of their responsibilities may be shared with non-physician providers. For instance, Nurse Practitioners and Physician Assistants can also make medical referrals, and most states (including California) authorize Physician Assistants to write prescriptions.

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Appointments

How can I make an appointment with a Sansum Clinic provider?

Each location schedules its own appointments; please contact your preferred location directly.

I am unable to keep my appointment. What do I do?

Please be sure to call your doctor's office promptly to reschedule or cancel at your earliest convenience possible.

Sansum Clinic's world renowned care keeps our highly-skilled doctors in constant demand. We understand that personal circumstances sometimes make it difficult to keep an appointment. However, canceling late denies other patients the opportunity to be seen during the time slot we've held for you. Because we value the time of all our patients and staff, we may charge a no-show fee under either of the following circumstances:

  • Less than 24 hours' notice
  • Missed appointment

As part our commitment to patient privacy, the webmaster does not have access to your medical records or appointments. It is important that you contact your doctor's office directly.

What form of ID do I need to need for check-in at my appointment?

New federal legislation has been passed to protect your financial and health-related information. You will need to present a Photo ID when checking in for an appointment. If you are paying by credit card or check, we will need to confirm that your name matches the name on the credit card or check you are using.

The photo ID must include both the patient's name and picture to be accepted.

Some common examples include drivers license, passport, state-issued ID, military ID, school ID, nursing home ID, club/gym/store membership cards, etc. If you are unsure whether your photo ID will be accepted, we invite you to check with clinic staff when scheduling the appointment.

For our pediatrics patients, the guarantor will need to present a photo ID at registration. A child of any ago may present their own photo ID instead of the guarantor's.

Which providers/departments can I see without a referral?
Please see "Do I need to join..." and "What is the difference..." above.
What is a "closed" practice? Can I still see my doctor if his or her practice has been closed?
This is status designation which applies only to HMO subscribers. It indicates that a physician's HMO practice has temporarily reached its maximum number of subscribers. The physician continues treating all of his or her existing patients, however additional HMO subscribers are not accepted until the practice is classified as "open" again.
I would like to see my doctor, but his or her schedule is booked for months in advance. What do I do?
The national and international reputation that Sansum Clinic has earned as a world-class health care facility keeps our providers in high demand. Each of these providers is committed to giving all patients the time and attention needed to maintain those standards of health care excellence. Although we regret that there are occasional scheduling delays with a few of our busiest providers, we are also proud to offer you the benefit of choice from among more than than 140 outstanding physicians. We encourage you to use our Find A Provider feature to search for the physicians who can best meet your needs.

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Insurance, Billing, and Accounts

Which insurance plans does Sansum Clinic accept?

Our insurance plans page details the HMO and PPO plans which we currently accept.

What treatments are covered by my insurance?

Insurers' coverage and restrictions vary widely and are subject to change by your insurance company. It is important that you check your insurance policy or consult your insurance plan administrator to ascertain both which services are covered and what requirements need to be met for the treatment to be covered by your specific insurance plan.

I have HMO insurance and my designated primary care physician (PCP) does not practice at Sansum Clinic. Will services I receive at Sansum Clinic be billed to me or to my HMO?

Prior to seeing a Sansum Clinic physician, you should obtain a referral from your primary care physician (PCP). For your convenience, we first submit a claim to your insurer following the provision of service. However, financial responsibility must be arranged directly between you and your HMO insurer (See also "I have health insurance. Why did I get a bill?"). Once we have heard from your HMO, the remaining balance, if there is any, will be billed to you. Keep in mind that we send statements to all patients monthly so you may receive an initial statement from us before your insurance has responded. If that is the case, please wait for your next statement to determine what your insurance has covered and what, if any, amount is your responsibility.

When should I expect to make my co-payment?

Co-payments need to be made prior to obtaining treatment. Please take care of your co-payment when you check in with registration for your appointment. Co-payments can be made by check, MasterCard, Visa, or in cash.

I paid my co-payment, but it was credited toward an earlier service. What happened?

Your account had a "balance due" amount for previous services. We automatically apply new payments to the oldest unpaid balance so when you submitted your co-payment, it was applied to your previous balance. Therefore, the amount of your current co-pay will be added to any remaining balance due amount.

I have health insurance, so why did I get a bill?

An initial statement is always sent to you so that you know what has been billed to your insurance company. It generally takes between one and two months for your insurer to make payment and/or recommend adjustments to your account. Therefore, it will be at least two months before we hear from your insurance company and learn what has been covered by your insurance plan.

Each insurer determines which services their plan will cover. You are financially responsible for any treatment which your insurance does not cover. So it is very important to read your insurance plan's benefits carefully, and to review the details with your plan administrator. There are several possible reasons why you might be billed for services.

One possibility is that the treatment did not meet the insurer's coverage requirements. For instance, typically an HMO requires, at a minimum, that:

  1. Your treatment is medically necessary; and
  2. The treatment is administered either by your designated primary care physician (PCP) or else by the physician whom your PCP has referred you to. For all other medical services, including emergencies, usually an HMO requires you to secure their authorization before obtaining the treatment.

Insurers also sometimes establish exceptions, known as "carveouts", for specific categories of treatment. Mental health and vision care are examples of services which are commonly carved out from basic medical coverage. These services may be covered under a separate plan having its own coverage requirements and possibly having different doctor/provider/facility contracts. So even when your primary insurance provides coverage for most Sansum Clinic care, that plan's coverage may not extend to certain categories of our specialty care such as mental health or vision care.

A third possibility is that the insurer pays less than 100% of the costs for the covered service. For instance, you may be responsible for making a co-payment, meeting a deductible, or covering fees in excess of the plan's payment cap. In that case, your bill will reflect that balance remaining after the insurer's payment has been received and deducted. (See also: "I paid my co-payment, but it was credited toward an earlier service.")

A fourth possibility is that your plan does not include coverage for this type of treatment. For instance, elective procedures are usually not covered, even when administered by your PCP.

NOTE: Whenever you are uncertain about whether — or how much — your treatment is covered by insurance, talk to your plan administrator or the insurer's customer service department.

I've received an explanation of benefits (EOB) from my insurance, stating that Sansum Clinic has been paid or an adjustment has been recommended on my account. So why did I get this bill?

You (the "subscriber") generally receive the explanation of benefits (EOB) before Sansum Clinic (the "provider") does. So allow at least three or four weeks after the date you receive the explanation of benefits before our statement to you will reflect that adjustment.

Who can I speak to about my bill?
Billing questions should be addressed to the Patient Accounts/Billing department. Phone numbers providing direct access to the department can be found by clicking the "Phone/Fax/Hours" button in the Patient Accounts/Billing page of our locations directory.
When should I call to check the status of my bill?

You may call the Patient Accounts/Billing department at any time. However, in order to allow enough time for your insurance to pay and for the clinic to make adjustments/ and/or corrections, please wait at least two billing statements (i.e. six to eight weeks) from your first bill before calling. You should also call if your insurance or any of your billing information changes.

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Urgent Care

What is the difference between "urgent care" and "primary care"?
The focus of "urgent care" providers is on treating minor emergencies, acute problems, and urgent medical needs — typically when a primary care physician may not be readily available. Urgent care is not a substitute for primary care, it is a supplement. Sansum Clinic urgent care services are available without appointment, and accessible during extended evening and weekend hours.
What is the difference between "urgent care" and "emergency room care"?
Conditions which need prompt attention, but are not life-threatening, may be appropriate for urgent care. Whereas crisis situations and conditions requiring immediate intervention — especially where there is risk of death or permanent impairment — require emergency room care. (Some examples of "urgent" vs. "emergency" conditions are listed on the Urgent Care department's page.)
Can I expect immediate treatment at Urgent Care? How long is the typical wait?
Emergency rooms must always give priority treatment to life-threatening conditions. The result is that patients whose injury or illness is less serious may need to wait a long time while emergency room staff are kept occupied with critical cases. For minor ailments, urgent care can usually provide equally effective treatment with less wait and at less expense. Some patients do arrive at urgent care with serious injuries and illnesses, and these patients are given priority. However, most patients are not seriously ill and are seen in order of arrival. Wait times vary depending on patient load. Occasionally a high volume of serious cases will extend wait times to 2 hours or more for non-critical patients, but typically patients can obtain urgent care treatment within 30 minutes to 90 minutes of their arrival.
For information about conditions which are appropriate for drop-in services at an urgent care versus those which require emergency room services, please see our Urgent Care department's page.

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Clinical Research

Are there any benefits and/or risks to being in a research study?

Research studies may be beneficial for its participants. Research studies help the participant take an active role in their own health care as well as gain access to new research treatments before they are widely available. Also, by being a participant you are helping others by contributing to medical research. Patients are the most important part of research!

As with all medical treatments, there are risks to participating. All known risks are fully disclosed. Some risks may include unpleasant, serious or even life-threatening side effects or it may not be effective at all for an individual participants. Some of the research studies may require more time and clinic visits. Lastly, experimental treatments must be evaluated for both immediate and long-term side effects.

Who pays for clinical research?

The sponsor of the study funds the costs to conduct the research trial. A sponsor could be a pharmaceutical company, medical school, or biotechnology company. The medical doctor (Principal Investigator) is compensated for his/her time spent on the project and the costs of procedures and medications are paid by the sponsor.

What are my rights if I take part in the study?
  • The decision to take part in a study is entirely your decision. No one can make you participate.
  • You can stop at any time. Your medical care at Sansum Clinic now, or in the future, will not be affected by your decision.
  • Sansum Clinic and/or the study sponsor can end your participation in a study at any time if it is felt to be in your best interest; if you do not follow the study rules; or if the study is stopped.
  • You will be told of important new findings or any changes in the study.
  • Your confidentiality is protected: data from the study may be published, but your name and other identifying information will not be sent outside of Sansum without written permission unless the law allows it.
  • These rights are protected by California's Informed Consent Guidelines which include the Experimental Subject's Bill of Rights.
What should I consider before participating in a research study?

You should know as much as possible about the study and feel comfortable asking the research staff questions about it, the care expected while in a study, and the cost of the trial. The following questions might be helpful for you to discuss with the health care team.

  • What is the purpose of the study?
  • Why do researchers believe the new treatment being tested may be effective? Has it been tested before?
  • Who is going to be in the study?
  • What kinds of tests and treatments are involved?
  • How do the possible risks and benefits in the study compare with my current treatment?
  • How long will my participation in the trial last?
  • Will hospitalization be required?
  • Will results of the study be provided to me?
  • Who will pay for the treatment?
  • Will I be reimbursed for other expenses?
  • What type of long-term follow up care is part of this study?
  • Who will be in charge of my care?
  • How might this trial affect my daily life?

Federal and state rules mandate that study participant informed consent be obtained and properly documented before a participant is enrolled in a study. In most cases the participant must sign and date a detailed informed consent form. Informed consent forms are written in understandable language. Sansum Clinic is committed to making sure that every research participant has a good understanding of their study. An informed consent form provides details about:

  • The purpose of the study
  • Which clinical procedures and laboratory tests will be used
  • How long the study will last
  • Whether you will be asked to allow biological samples to be stored for future research, such as blood and tissue samples
  • The risks and benefits of the study
  • Treatments other than the experimental one that are currently available for your illness
  • The dollar amount, if any, you will receive for participation
  • Compensation for study-related injury
  • Expected costs of tests and procedures and who will pay for them
  • Confidentiality of health information
  • Whom to contact with questions

You can learn more from California's Informed Consent Guidelines including the Experimental Subject's Bill of Rights

What are the phases of a clinical trial?
Phase I
This is the first phase of clinical trials. The drug is introduced into human subjects after years of preclinical testing. The drug is administered at a variety of doses to achieve the therapeutic index of the drug. By identifying the toxic dose and the minimum therapeutic dose, one will determine some side effects and the metabolism of the drug into the human system. At this stage of trials, the number of subjects is fairly small and most of the subjects are fairly healthy.
Phase II
In this phase, the goal is to determine the common short-term side effects and risks. The drug is administered at various doses to determine the most effective and best tolerated dose. The subjects typically have the disease or ailment that the drug was targeted for. The sample size is larger than the size for Phase I trials.
Phase III
At this stage, usually the therapeutic dose has been determined and this is for further identification of side effects or other ailments caused by this compound. The goal is to gather additional information on the effectiveness/safety of the drug. The marketing and labeling of the drug will also be determined at this stage of development. Usually more subjects are admitted into this stage of development. If there are no major serious adverse effects that are attributed to the compound of study, the sponsor will usually apply for FDA approval after or during these Phase III trials.
Phase IV
Currently some aspects can be incorporated into Phase III trials. Phase IV studies are usually completed to determine cost-effectiveness for marketing the drug and the various doses the drug can be administered to the subjects. Most Phase IV trials are done when the sponsor determines the best way to market the product.

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Laboratory

Must I have an order from a Sansum Clinic physician to use laboratory services?
No. Our laboratory services are provided by Pacific Diagnostic Laboratories (PDL), an independent affiliate. PDL honors orders written by Sansum Clinic physicians, as well as many others. Please contact PDL directly for more information about their policies.

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Pharmacy

Why do things work differently at the pharmacy on Pueblo?

Sansum Pharmacy, located at 317 W Pueblo St in Santa Barbara, is an independently-owned and -operated business which coincidentally shares a location and similar name with us. It is a separate and unaffiliated business which sets its hours and policies independently.

The Prescription Pharmacy at Sansum Clinic, 215 Pesetas Lane, Santa Barbara, CA 93110 and Prescription Pharmacy at Sansum Clinic, 51 Hitchcock Way, Santa Barbara, CA 93105 are owned and operated by us.

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Other

How can I contact my doctor after office hours (evenings, weekends, etc.)?
Medical treatment or consultation after office hours should be handled by urgent care or an emergency room (see "What is the difference between 'urgent care' and 'emergency room care'" above).
How can I obtain a copy of my medical records?
Records can be obtained by contacting the Medical Records Correspondence department at (805)898-3188. For more information about your rights regarding medical records, see "Privacy Practices for Protected Health Info"
Does Sansum Clinic offer classes?
Yes, we offer classes in both north county and south county. Our course topics cover many subjects, including diabetes, nutrition, parenting, and stress management. Courses range from a few hours to several weeks in length. Most offerings are free or low-cost. Upcoming courses dates can be found in our Santa Barbara education calendar and Lompoc education calendar.
Does Sansum Clinic have a toll-free number for long-distance callers?
Yes. Our local and toll-free primary switchboard numbers are listed on the Contact Us page. Direct-dial numbers and office hours for departments within each of our locations can be found by clicking the site's name, then clicking its "Phone/Fax/Hours" button.
I have additional health-related questions. Where can I find more specific information?
To learn about any of the more than 30 specialties offered by Sansum Clinic, browse our Departments section and/or Specialty Services section. Articles describing specific medical conditions and treatments are catalogued in the Community Education section. Community Education is also home to the Health Info On The Web page, maintaining categorized links to dozens of third-party health reference resources on the internet.
Some of the medical/financial/insurance terminology is hard to understand. Is there a guide for this stuff?

Yes! Please see our Glossary for definitions of many common terms and acronyms. If you notice a term which deserves to be added to the Glossary, please also suggest it to our Webmaster.

I would like to offer a compliment or complaint. How can I communicate it to the right person within Sansum Clinic?

Give a Compliment

Keeping you healthy is our mission; delivering warm, compassionate care is our pleasure. The personal stories and kind compliments of patients are part of what inspire our staff to maintain Sansum Clinic's history of excellence. If you have a compliment about our patient care, we welcome the opportunity to hear it:

Submit a Complaint

We take pride in providing outstanding health care in a compassionate and caring environment. If you have experienced a problem with any Sansum Clinic service, we want to fix it. A confidential complaint may be submitted either:

I would like to help support Sansum Clinic's mission of providing quality health care to the community. How can I get involved?
Thank you. As a nonprofit 501(c)(3) organization, we depend on donations like yours to help sustain valuable health care services for now and the future. The generosity of thousands of donors and volunteers has made a tangible difference for the families and communities of Santa Barbara County. Whether you want to make a one-time gift, renew an annual gift, designate a legacy gift, or offer the gift of your own time, the Philanthropy department is available to provide all the information you need.

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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.

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