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Monday, October 7 the Children's Mercy Northland locations will be open for Save
My Spot appointments only. Walk-in appointments will be unavailable. Reserve
your time with Save My Spot.

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INSURANCE PLANS AND COVERAGE TYPES ACCEPTED

Para ver esta página en Español haga clic aquí

Resources
Save time! Pre-register online

What if I have an Out-of-Network plan?

Out-of-pocket cost comparison for in network vs. out of network

Contact an insurance navigator

Kansas Insurance Department

Missouri Department of Insurance

Medicaid Renewal Update



DOES YOUR INSURANCE PLAN
INCLUDE CHILDREN'S MERCY?


Navigating your family’s health insurance plan coverage can be complicated,
especially with all options available. But one thing is simple: if you have a
child, make sure your health plan includes Children’s Mercy.

Children’s Mercy contracts with many insurance plans and networks to provide
health care services to their participants. Here, you will find a list of plans
we contract with and accept.

Please note, participation with these plans is not a guarantee of payment or
coverage. Many insurance plans require a referral or prior-authorization for
coverage of certain services. It is important to check with your insurance plan
to ensure your specific benefits include coverage for services at Children’s
Mercy. If you have questions regarding your benefits and coverage, please
contact your insurance plan directly.

ACA Marketplace / Exchange plans


IN-NETWORK

 * Aetna CVS Health
 * BlueKC (BlueSelect Plus & Preferred Care Blue)
 * BCBS Kansas BlueChoice
 * Cigna Simple Choice (Not a 2024 Exchange Option) 
 * Medica (Medica Connect, Medica with MU HealthCare, & Select by Medica) 


OUT-OF-NETWORK

 * Ambetter from Home State Health (Missouri) 
 * Ambetter from Sunflower Health Plan (Kansas)
 * Balance by Medica (offered in SW MO)
 * Blue KC BlueSelect
 * Cox Health (offered in SW MO only)
 * Oscar Health
 * United Healthcare [Gold, Silver, Bronze]
 * US Health and Life - Ascension Personalized Care (offered in Wichita market)
 * Well First by Medica (offered in St. Louis)

In-Network plans that include Children's Mercy


COMMERCIAL

 * Aetna
   * CareLink 
 * American Healthcare Alliance
 * Anthem BCBS of Missouri (utilizing BlueKC network)
 * Ascension (utilizing BlueKC network)
   * Ascension Personalized Care EPO (Out-of-Network)
 * BlueKC
   * Blue Access (Out-of-Network)
   * BlueCard PPO (plans with PPO suitcase on ID card)
   * BlueSelect (Out-of-Network)
   * BlueSelect Plus
   * High Performance Network
   * Freedom
   * Freedom Network Select
   * Preferred Care
   * Preferred Care Blue
   * Preferred Health Professionals
 * BCBS of Kansas BlueChoice Solutions (formerly BCBS Kansas Solutions)
 * Cigna (including Great-West Healthcare)
   * Cigna + Oscar
   * Cigna Plus
   * Cigna SureFit
   * HealthPartners
   * LocalPlus or LocalPlusIN
   * MVP Health Care
   * Network Open Access
   * Open Access Plus
   * PriorityHealth
   * Simple Choice (formerly Cigna Connect)
   * Tufts Health Plan
 * Centivo Network
 * CoxHealth Network
   * EPO Exchange (Out-of-Network)
 * CoxHealth Plans (utilizing First Health Network)
 * FAIROS (powered by OccuNet)
 * First Health Network
 * GEHA (utilizing UHC network)
 * HealthLink HMO
 * HealthLink Open Access
 * HealthLink PPO (utilizing Freedom Network)
 * Well Care
 * Humana
 * Medica
   * Balance by Medica (Out-of-Network)
   * Medica Choice National (utilizing the First Health Network)
   * Medica Connect (utilizing ProviDRs Care network)
   * Medica with MU Health Care (referral required)
   * Select by Medica
 * Mercy Health Springfield Communities
 * MultiPlan (excluding all health and/or cost sharing ministries)
 * National Preferred Provider Network
 * Orscheln Industries (utilizing HealthSCOPE TPA)
 * PHCS (excluding all health and/or cost sharing ministries)
 * ProviDRs Care (formerly WPPA)
 * QuikTrip
 * United Healthcare (UHC)
   * ACA Exchange [Gold, Silver, Bronze] (Out-of-Network)
   * All Savers
   * Custom Network Plan (Out-of-Network)
   * Deere Premier (Out-of-Network)
   * Surest (limited benefit coverage)
   * UHC Core Essential
   * UHC Choice & Choice Plus
   * UHC Navigate
   * UHC NexusACO
   * UHC Options
   * UHC Select
   * UMR
 * USA Managed Care Organization
 * WellFit (utilizing Centrus Health)


FEDERAL PLANS

 * Tricare/Health Net Federal Services 
   * East and West plans 
   * Prime plans require a PCM referral 


STATE MEDICAID PLANS


If you have Medicaid coverage and do not live in Kansas or Missouri, please
contact your State Medicaid Agency or Health Plan to verify that Children’s
Mercy Kansas City is authorized to provide care to your child prior to seeking
services. Many States have special requirements that need to be followed before
seeking services from an out of State provider and if these are not followed you
may not have coverage and be financially responsible for the care you receive at
Children’s Mercy Kansas City. The phone number to call for this information
should be located on your benefit card that is provided by your State Medicaid
Agency or Health Plan when you become eligible for Medicaid coverage.

 * Arkansas Medicaid/ARKids First (referral required) 
   * Arkansas Medicaid - Arkansas Total Care (Out-of-Network)
   * Arkansas Medicaid - Empower Healthcare Solutions (Out-of-Network)
   * Arkansas Medicaid - Summit Community Care (Out-of-Network)
   * Arkansas Medicaid PASSE (Out-of-Network) 
 * Oklahoma Medicaid/SoonerCare (referral required)
   * Oklahoma Medicaid SoonerSelect - Aetna Better Health (Out-of-Network)
   * Oklahoma Medicaid SoonerSelect - Humana Healthy Horizon (Out-of-Network)
   * Oklahoma Medicaid SoonerSelect - Oklahoma Complete Health (Out-of-Network)

STATE MEDICAID MANAGED CARE PLANS MEDICAID PLANS



 * Kansas
   * Aetna Better Health 
     * SkyGen USA Dental
     * SkyGen USA Vision
   * Sunflower Health Plan
     * Envolve Dental (Out-of-Network)
     * Envolve Vision
   * United Healthcare Community Plan
     * SkyGen USA Dental
     * MARCH Vision Care (Out-of-Network)
       
       
 * Missouri
   * Healthy Blue
     * DentaQuest
     * MARCH Vision Care (Out-of-Network)
   * Home State Health/ Show Me Healthy Kids
     * Envolve Dental
     * Envolve Vision
   * United Healthcare Community Plan
     * United Healthcare Dental
     * MARCH Vision Care (Out-of-Network)
       
       


SPECIALTY NETWORKS


BEHAVIORAL HEALTH (OUTPATIENT)

 * Cenpatico
 * Evernorth Behavioral Health (formerly Cigna Behavioral Health)
 * Lucet Behavioral Health (formerly New Directions)
 * Optum / United Behavioral Health

CENTERS OF EXCELLENCE - TRANSPLANT NETWORKS

 * Aetna Institutes of Excellence (IOE)
   * BMT, Heart, Kidney, Liver
 * Blue Distinction Centers for Transplant (BDCT)
   * BMT, Heart, Liver
 * Cigna LifeSOURCE Transplant Network Designated Programs
   * BMT, Kidney 
 * Humana National Transplant Network  
   * BMT, Kidney 
 * LifeTrac/Emerging Therapy Solutions (ETS) Programs of Excellence
   * BMT, Heart, Kidney, Liver 
 * Optum Pediatric Transplant Centers of Excellence Network
   * BMT, Heart, Kidney 
 * Optum Pediatric Transplant Access Program (TAP) 
   * Liver

DENTAL

 * Delta Dental
 * DentaQuest 
 * Envolve Dental (Home State Health & Show Me Healthy Kids)
 * MetLife
 * SkyGen USA (formerly Scion Dental)

VISION

 * Envolve Vision/Opticare
 * SkyGen USA (formerly Ocular Benefits)
 * Vision Service Plan (VSP)

Narrow network plans that include Children’s Mercy

A narrow network is a type of health plan that requires members to receive care
in their preferred, narrow network of a select group of doctors, hospitals,
outpatient facilities, laboratories, etc.

 * Aetna KC Care Network Plus (formerly I-35 Preferred)
   * Adult Health System Network: AdventHealth Shawnee Mission, KU Medical
     Center, Liberty Hospital, HCA MidWest Health, North Kansas City Hospital,
     Olathe Health, University Health
 * Aetna Connected
   * Adult Health System Network: AdventHealth Shawnee Mission, KU Medical
     Center, Liberty Hospital, HCA MidWest Health, North Kansas City Hospital,
     Olathe Health, University Health
 * BlueKC High Performance Network
   * Adult Health System Network: Saint Luke’s Health System
 * Cigna Sure Fit
   * Adult Health System Network: HCA MidWest Health, North Kansas City Hospital
 *  Cigna Local Plus
   * Adult Health System Network: HCA MidWest Health, North Kansas City Hospital
 * UHC Core Essential
 * * Adult Health System Network: Saint Luke’s Health System
     
     

Out-of-Network plans that exclude Children's Mercy


MEDICAL

 * Ambetter from HomeState Health Plan (MO)
 * Ambetter from Sunflower Health Plan (KS)
 * Anthem Pathway/Pathway X (KS locations only)
 * Arkansas Medicaid Provider-Led Arkansas Shared Savings Entity (PASSE) 
   * Arkansas Total Care
   * CareSource
   * Empower Healthcare Solutions
   * Summit Community Care
 * Ascension Personalized Care EPO
 * Aspen STM (All Hospital/Facility Services)
 * Balance by Medica
 * BlueKC Blue Access 
 * BlueKC Blue Select
 * Cox Health EPO
 * Custom Network Plans (Administered by United Healthcare)
   * Custom Network Plan
   * Deere Premier
 * HealthChoice of Oklahoma 
 * Kaiser Permanente
 * LifeShield STM (All Hospital/Facility Services)
 * MedBen
 * Mercy Anthem Alliance EPO (Anthem BCBS) 
 * Oklahoma Medicaid SoonerSelect (Managed Medicaid plans Only)
   * Aetna Better Health of Oklahoma
   * Humana Healthy Horizon
   * Oklahoma Complete Health
 * Oscar Health
 * PHCS Practitioners Only (All Hospital/Facility Services)
 * Preferred CommunityChoice
 * Prime Health Services (PHS)
 * United Healthcare [Gold, Silver, Bronze]
 * US Health and Life - Ascension Personalized Care (offered in Wichita market)
 * Walmart / Mercy: Arkansas Local Plan & Southwest Missouri Local Plan
 * Well First by Medica (offered in St. Louis)
 * All other Medicaid and Managed Medicaid plans outside of the states of
   Arkansas, Kansas, Missouri, and Oklahoma.


BEHAVIORAL HEALTH

 * Beacon Health Options (formerly Value Options)
 * Magellan Healthcare
 * Mercy Managed Behavioral Health


DENTAL

 * Envolve Dental (Sunflower Health Plan)
 * Oklahoma Medicaid SoonerSelect Dental Plans
   * DentaQuest
   * LIBERTY Dental
 * United Concordia Dental


HOME CARE

 * Humana


THERAPY

 * TheraMatrix (BCBS of Michigan)


VISION

 * EyeMed
 * March Vision Care
 * Vision Care Direct

Questions to consider when selecting your health care plan

Q: What are the options for purchasing health insurance for my child?

Options include:

 * Get it through your employer.
 * Buy it on the Health Insurance Exchange at www.healthcare.gov.
 * Buy it from an insurance company, agent or broker.
 * Apply for Medicaid
 * *  Missouri Medicaid
   *  Kansas Medicaid

Q: What is a Health Insurance Exchange?

The Health Insurance Exchange at www.healthcare.gov was designed as a one-stop
shop to find, compare and buy private health insurance options.

Neither Missouri nor Kansas have their own state exchange, so you'll find your
options on the federal Health Insurance Exchange at www.healthcare.gov.

Q: When can I enroll/when is open enrollment for insurance coverage on the
Health Insurance Exchange (www.healthcare.gov)? Can I enroll outside open
enrollment time period?

Open enrollment (enrollment for anyone) is Nov. 1 – Jan. 15 annually, but you
may enroll year-round if:

 * You experience certain life events like:
   * Getting married
   * Having a baby/ adopting a child 
   * Moving to a new area
   * Losing health coverage

These may qualify you for a special enrollment period. You can see if you
qualify for any of these at www.healthcare.gov/screener/.

More details and updated dates available at
www.healthcare.gov/marketplace-deadlines.

Q: My child is a patient at Children's Mercy, or I want my child to be seen at
Children's Mercy in the future. What do I need to know about my health insurance
coverage?

When choosing any plan, even a plan purchased through your employer or outside
of the Exchange, you should always make sure Children's Mercy is an in-network
provider so that your child can continue care or receive care at Children's
Mercy in the future. 

Those plans that exclude essential providers like Children's Mercy have two
deductibles: One for services at in-network providers and one for services at
out-of-network providers. Out-of-pocket costs could be higher if your child
visits a provider who is out-of-network with your insurance plan.

Q: What should I consider when comparing health insurance?

When comparing, consider these things:

 * What is covered?
 * What is my monthly cost?
 * What is my deductible?
 * What is my coinsurance and copay?
 * Which providers can I see with this plan?/ Which providers are in-network
   with this plan?
 * Annual out-of-pocket maximum for in-network services and annual out-of-pocket
   maximum for out-of-network services?

Q: How do I know or how do I make sure Children's Mercy is included in my plan?

You can contact your insurance plan or visit the links above for a listing of
in-network insurance plans with Children's Mercy. 

Q: What can I do if my insurance plan doesn't cover Children's Mercy, I was
denied coverage or I am unhappy with my insurance?

You are the best advocate for your child. We encourage you to call the
Department of Insurance (DOI) with concerns regarding the availability of
providers within your insurance plan’s network, the timeframe for getting a
response to your inquiry(ies), or anything else about your health insurance. The
DOI oversees the insurance industry and protects you as an insurance consumer.

 * Kansas Department of Insurance-(800) 432-2484
 * Missouri Department of Insurance-(800) 726-7390

Q: Why is Children's Mercy not a provider on all plans?

We continue to negotiate with insurance plans. Despite our best efforts, we have
found that some plans have chosen not to contract with us.

Our hope is that all insurance plans will cover Children's Mercy, especially
since many services are not provided elsewhere in the region, so we can serve
your child and all children in Kansas and Missouri.

Q: Is there anything I can do to help ensure Children's Mercy is included in
insurance plans?

Contact your employer or insurance plan and tell them you think Children's Mercy
is an essential provider for any health plan network.

Q: I'm an adult patient at Children's Mercy. How do I get coverage?

Please contact our financial counselors at (816) 234-3567  and they can help.

Q: What if my child is seen at Children's Mercy and does not have insurance?

Please contact our financial counselors at (816) 234-3567 and they can help.

Insurance forms
 * Aetna Coordination of Benefits Form
 * Blue Cross Blue Shield Coordination of Benefits Questionnaire
 * Blue Cross Blue Shield Duplicate Coverage Form
 * Blue Cross Blue Shield of Kansas Duplicate Coverage Form
 * Cerner Coordination of Benefits Questionnaire
 * Cigna Coverage Update Form
 * Kansas Medicaid Third Party Liability Form
 * Missouri HealthNet Accident Report
 * Missouri HealthNet Insurance Resource Report
 * Tricare Third Party Liability Form
 * United HealthCare Coordination of Benefits Form

Cost share/health care sharing plans

The No Surprises Act defines an uninsured individual as:

 * A patient who has no insurance and is self-pay.
 * A patient who has a short-term medical plan.
 * A patient who has a cost share or ministries sharing group coverage.
 * A patient who has a limited benefits plan.

What is a cost or health care sharing plan?
A cost share or health care sharing plan is provided by organizations whose
members “share” medical costs. As part of a health care sharing plan, you are
responsible for paying certain share amount each month (like a premium) as well
as an “annual unshared amount” for your own expenses (like a deductible) that
your medical expenses must exceed before the plan shares your expenses. 

Does Children’s Mercy accept cost sharing plans?
Per the No Surprises Act, individuals with a cost share or health care share
plan are uninsured. Therefore, any patient who is enrolled in a sharing plan
will be identified as self-pay, or uninsured, when seeking care at Children’s
Mercy. Within three days of your appointment being scheduled, a member of
Children’s Mercy’s Financial Clearance team will call you to provide a good
faith estimate for services the child may receive as part of the scheduled
appointment.  

How does billing work if I have a cost share plan?
You will receive a statement for services received with the appropriate self-pay
discount already applied. You may forward your statement to your cost share
group for review and reimbursement, but you are ultimately responsible for
payment regardless of whether your cost share group reimburses you or not.
Please note, Children’s Mercy will not send a claim or statement to the cost
share group directly; it is your responsibility to submit to your cost share
group.

Uninsured, self-pay and short-term policies

The No Surprises Act defines an uninsured individual as:

 * A patient who has no insurance and is self-pay
 * A patient who has a short-term medical plan
 * A patient who has a cost share or ministries sharing group coverage
 * A patient who has a limited benefits plan

Can my child be scheduled for an appointment if they do not have insurance?

Yes! Within three days of your appointment being scheduled, a member of the
Children’s Mercy’s Financial Clearance team will call you with a good faith
estimate for the services the child may receive as part of the scheduled
appointment.

If my child does not have insurance, how can they get coverage?

 * You can enroll in the health care exchange during the open enrollment period,
   or if you meet the definition of a life event at healthcare.gov.  
 * Review the information on this page to confirm what exchange plans are
   in-network with Children’s Mercy
 * You can contact a Children’s Mercy Financial Counselor for help
   enrolling/applying for insurance. A counselor can also screen you for one of
   Children’s Mercy’s financial aid programs.

How much will I owe if my child does not have insurance?

Families who are defined as uninsured will be eligible for the self-pay
discounted rate. You can run a patient estimate for services that your child may
receive.

Practitioner/provider only plans

If your insurance card references any of the terms listed below, you likely have
limited coverage at Children’s Mercy for the services your child may need

 * Practitioner Only
 * Ancillary Services
 * Hospital/Facility Based Charges
 * Referenced Based Pricing or Accepting Medicare Rates

Typically, these plans will only cover the office visit with a doctor or nurse
practitioner, but no additional services outside of meeting with the provider. 
Children’s Mercy bills as an outpatient hospital, which means that services are
most likely not covered at all, or have very limited coverage. To avoid paying
higher out-of-pocket costs, contact your health plan to ask where you child can
receive care that will be covered by your insurance plan. If there is not
another provider that your plan will cover, ask your plan how you can seek
approval to have these services at Children’s Mercy.

To ensure your child’s services will be covered by your insurance plan, follow
the OON Appointment Request process.

EXAMPLES OF HOSPITAL BASED CHARGES THAT WILL MOST LIKELY NOT COVERED BY A
PRACTITIONER ONLY PLAN:


Diagnostic testing: Any lab, radiology, blood/urine/saliva lab, genetic testing,
X-rays, ultrasounds, CT/MRI’s, IVR’s PET scans, nuclear medicine studies,
echocardiograms, sleep studies, EEG’s, allergy testing, and/or development,
behavioral, or psychology testing

Therapy services: New/established patient evaluations or therapy/services with a
physical therapist, occupational therapist, speech therapist, audiologist, or
development/behavioral or psychological services

Medications: Including but not limited to oral, injected, infused medications or
implants

In-office or surgical procedures: Circumcisions, bone/fracture care, laser
procedures, colonoscopies, or any services in an operating room, procedure room,
or in a clinic

Facility charges: including Inpatient or Observation stay, and ground/air
ambulance

*This list is not an all-inclusive list. Please email  NarrowNetwork@cmh.edu for
questions related to specific services.


WHY CHOOSE CHILDREN'S MERCY?


Children's Mercy is ranked as one of America's best pediatric hospitals by U.S.
News and World Report. With our world-renowned Genome Center, the region's only
Level IV Neonatal Intensive Care Unit (NICU) and more than 760 pediatric
specialists in 40 specialties, we're the region's only hospital completely
focused on treating kids — all in an environment specifically designed for the
way kids need to be treated. As the region's only children's hospital,
Children's Mercy is an essential provider to the community. There are many
reasons our families come here, community providers refer to Children's Mercy
and insurance plans cover our services including:

 * 90% of all pediatric specialists (physicians only) in the Kansas City metro
   are at Children's Mercy.
 * Children's Mercy has 40 areas of specialties, 19 of which are only offered in
   the Kansas City metro by pediatric subspecialists at Children's Mercy.
 * U.S. News and World Report ranks Children's Mercy as one of the best
   children's hospitals, ranking us in 9 specialties: Cardiology & Heart
   Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery,
   Neonatology, Nephrology/Kidney, Neurology & Neurosurgery, Orthopedics,
   Pulmonology & Lung Surgery, and Urology.
 * Children's Mercy received nursing's highest honor, Magnet Designation, from
   the American Nurses Credentialing Center for the fifth time in 2020.

Financial Resources and Billing menu
 * Billing Process
 * Comprendiendo los Costos de Atención Médica
 * Contact Us
 * Cost of Care Estimate Tool
 * El Seguro
 * FAQ: Understanding Health Care Costs
 * Financial Counseling
 * Financial Resources and Billing Information
 * Guarantor Change Request Form
 * Insurance Plans and Coverage Types Accepted
 * Insurance Terms and Definitions
 * Ley de No Sorpresas
 * Medicaid Renewal Update
 * No Surprises Act
 * Pay My Bill
 * Transition to Adulthood - Medical Insurance Choices for Adults
 * Update Insurance Card or Demographics
 * Your Visit
 * Payment Types Accepted


Children's Mercy Kansas City   /    Your Visit   /    Financial Resources and
Billing Information   /   Insurance Plans and Coverage Types Accepted by
Children's Mercy
For patients and families
(816) 234-3000

Toll Free
(866) 512-2168

For providers: urgent consults, admissions, transports
(800) GO MERCY
(800) 466-3729
For deaf/hard of hearing callers
TTY - 711


--------------------------------------------------------------------------------

Magnet Designation. Recognizing excellence in nursing for the top 8 percent of
hospitals nationally.

U.S. News & World Report. Voted one of America's best children's hospitals.
Ranked in 9 specialties.


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children and their families.

Children’s Mercy is a 501(c)3 charitable organization.

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Financial Resources and Billing menu
 * Billing Process
 * Comprendiendo los Costos de Atención Médica
 * Contact Us
 * Cost of Care Estimate Tool
 * El Seguro
 * FAQ: Understanding Health Care Costs
 * Financial Counseling
 * Financial Resources and Billing Information
 * Guarantor Change Request Form
 * Insurance Plans and Coverage Types Accepted
 * Insurance Terms and Definitions
 * Ley de No Sorpresas
 * Medicaid Renewal Update
 * No Surprises Act
 * Pay My Bill
 * Transition to Adulthood - Medical Insurance Choices for Adults
 * Update Insurance Card or Demographics
 * Your Visit
 * Payment Types Accepted


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