Insurance Plans & Healthcare Networks

Sansum Clinic is pleased to be included in the individual exchange/non-exchange network for Blue Shield and Blue Cross of California. See our Frequently Asked Questions about Covered CA and other Insurance Exchange Networks. Please visit Blue Shield of California, Health Net or http://www.coveredca.com/ for more information.

We accept Medicare, many Medicare Advantage Plans, Medicare Part D, CenCal Health Plans, many HMO plans, many PPO plans, some EPPO plans, some EPO plans, many Mental (Behavioral) Health Plans, some Vision and Eyewear Plans, and many Workers Compensation Plans. At each visit, you should:

Bring picture identification and any insurance cards
Stop at the Registration desk
Update your registration information

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

Receive a new insurance identification card
Are assigned to another provider group (HMO) not affiliated with Sansum Clinic
Select a new primary care physician (PCP)
Change your address, name, or phone number changes, and/or
Are in an EPPO or EPO plan with no out-of-network benefits

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, your benefit administrator or your broker, as is appropriate to find out if Sansum Clinic is a provider under your specific plan before deciding.

Plan Types

Health Maintenance Organization (HMO)Preferred Provider Organization (PPO)
Exchange/Non-Exchange Individual and Small Group Plan (EPPO)
Exclusive Provider Organizations (EPO)
Medicare Advantage Plans (HMO, PPO, Pharmacy, Resources)
Other Government Plans
Medi-Cal HMO Plans
Other Publicly-Funded Health Plans
Ambulatory Surgery Centers
Mental (Behavioral) Health Carveout
Workers Compensation
Eyewear and Refractions
Individual Medicare Plan Options

According to www.Medicare.gov you may enroll in plans from October 15 to December 7 annually.

Medicare Options at Sansum Clinic:

AARP Medicare Complete (individual)
Members: (800) 950-9355 Non-Members: (800) 547-5514
For patients living outside of Santa Barbara County, we accept Anthem Medicare Preferred Standard PPO Plans (formerly known as Blue Cross Freedom Blue PPO)

Sansum Clinic recommends the following resources for assistance in understanding your Medicare options:

Health Insurance Counseling and Advocacy Program (HICAP) for free unbiased Medicare counseling
www.cahealthadvocates.org/HICAP
(800) 434-0222
The Official U.S. Government Site for Medicare and Center for Medicare and Medicaid Services
www.Medicare.gov

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: https://openpaymentsdata.cms.gov.

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: https://openpaymentsdata.cms.gov.

Individual Exchange/Non-Exchange Plan Options

Please check CoveredCA.com for open enrollment dates.

Individual Plan Options at Sansum Clinic:

Blue Shield EPPO - Exchange/Non-Exchange (narrow) Provider Organization (EPPO)

Small Group Exchange/Non-Exchange Options

Sansum Clinic recommends the following resources for assistance in understanding your Exchange Plan options:

CoveredCA.com