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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

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.

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:


Health Plan Assistance

For basic assistance in understanding your health plan type, Sansum Clinic offers:

Health Resource Center
215 Pesetas Lane, First Floor
(805) 681-7672
Monday – Thursday 9:00 am to 4:00 pm
Friday 9:30 am to 12 noon


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