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Insurance

Does your insurance plan
include 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. Most insurance companies require a referral or prior-authorization for coverage of 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 carrier directly.

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

In-Network

  • Aetna CareLink

  • BCBS Kansas BlueChoice (formerly BCBS Kansas Solutions)

  • BlueKC BlueSelect Plus

  • BlueKC Preferred Care Blue

  • BlueKC Blue Choice

  • Cigna Simple Choice (formerly Cigna Connect)

  • Medica - Medica Connect (utilizing ProviDRs Care Network)

  • Medica - Medica with MU Health Care (referral required)

  • Medica - 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 and St. Louis)

  • Blue KC BlueSelect

  • Cox Health (offered in SW MO only)

  • Oscar Health

  • United Healthcare

  • US Health and Life (utilizing Ascension)

Commercial

 

  • Aetna

  • American Healthcare Alliance

  • Anthem BCBS of Missouri (utilizing BlueKC 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

  • Cigna (including Great-West Healthcare)

    • Cigna + Oscar
    • Cigna Plus
    • Cigna SureFit
    • Connect
    • HealthPartners
    • LocalPlus or LocalPlusIN
    • MVP Health Care
    • Network Open Access
    • Open Access Plus
    • PriorityHealth
    • Tufts Health Plan

  • CoxHealth Network

  • CoxHealth Plans (utilizing First Health Network)

  • First Health Network

  • HealthLink HMO

  • HealthLink Open Access (OA)

  • HealthLink PPO (utilizing Freedom Network)

  • Health Midwest Comprehensive Care (HMCC) 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)

    • All Savers
    • Custom Network Plan (Out-of-Network)
    • Deere Premier (Out-of-Network)
    • GEHA
    • Surest (limited benefit coverage)
    • UHC Core Essential
    • UHC Choice & Choice Plus
    • UHC Navigate
    • UHC NexusACO
    • UHC Options
    • UHC Select
    • UMR

  • USA Managed Care Organization

Government Insurance 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.

Federal Plans

  • TriCare/Health Net Federal Services

State Medicaid Plans

  • Arkansas Medicaid

  • Kansas Medicaid

  • Missouri Medicaid

  • Oklahoma Medicaid (referral required)

Managed Medicaid Plans - Kansas

  • Aetna Better Health

    • SkyGen USA Dental
    • SkyGen USA Vision

  • Sunflower Health Plan

  • United Healthcare Community Plan

Managed Medicaid Plans - Missouri

  • Healthy Blue

  • Home State Health

  • United Healthcare Community Plan

Specialty Networks


Behavioral Health (Outpatient)

  • Cenpatico

  • Evernorth Behavioral Health (formerly Cigna Behavioral Health)

  • MHNet Behavioral Health

  • New Directions Behavioral Health

  • Optum / United Behavioral Health

Specialty Centers of Excellence - Transplant Networks

  • Aetna Institutes of Excellence

  • Blue Distinction Centers (BDC) for Transplant

  • Cigna LifeSOURCE Transplant Network

  • Humana National Transplant Network

  • Optum Pediatric Transplant Centers of Excellence Network

Dental

  • Delta Dental

  • DentaQuest

  • MetLife

  • SkyGen USA (formerly Scion Dental)

Vision

  • Envolve Vision/Opticare

  • SkyGen USA (formerly Ocular Benefits)

  • Vision Service Plan (VSP)

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 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

See the out-of-pocket cost comparison to paying through an insurance plan.

What steps can I take if I have an out-of-network plan?

Medical

  • Ambetter from HomeState Health Plan (MO)

  • Ambetter from Sunflower Health Plan (KS)

  • Anthem Pathway/Pathway X (KS locations only)

  • Ascension

  • Aspen STM (All Hospital/Facility Services)

  • Balance by Medica

  • Blue Access (BCBS of Kansas City)

  • Blue Select (BCBS of Kansas City)

  • 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)

  • Medicaid Arkansas CareSource PASSE

  • Medicaid Arkansas Empower PASSE

  • Medicaid Arkansas Total Care PASSE

  • Medicaid Arkansas Summit PASSE

  • Mercy Anthem Alliance EPO (Anthem BCBS) 

  • Oscar Health

  • PHCS Practitioners Only (All Hospital/Facility Services)

  • Preferred CommunityChoice

  • Prime Health Services (PHS)

  • Walmart / Mercy: Arkansas Local Plan & Southwest Missouri Local Plan

  • All Medicaid and Managed Medicaid plans outside of the state of Missouri or Kansas will have pre-approvals that are needed to receive care at Children’s Mercy. The requirements can be found in the Out-Of-Network or Out-of-State Medicaid Plans section of this page.

Behavioral Health

  • Beacon Health Options (formerly Value Options)

  • Magellan Healthcare

  • Mercy Managed Behavioral Health

Dental

  • Envolve Dental

Home Care

  • Humana

Therapy

  • ETS (formerly LifeTrac)

Transplant Network

  • TheraMatrix (BCBS of Michigan)

Vision

  • EyeMed

  • March Vision Care

If the patient resides in a state other than Missouri or Kansas and has Medicaid insurance coverage through their state, pre-approvals will be required for the patient to receive care outside of his/her home state.

For some plans, this could mean a simple referral from your child’s primary care provider within his/her state of residence. In most cases, however, even with an approved referral, the appointment will need to go through the Out-of-Network (OON) appointment request process.

Arkansas Medicaid
Requires a referral from an enrolled Arkansas Medicaid provider unless coverage is through one of the managed care plans listed below:

Oklahoma Medicaid
Requires a referral from an enrolled Oklahoma provider.

Iowa Medicaid
Follow OON appointment request process.

Nebraska Medicaid
Follow OON appointment request process.

Colorado Medicaid
Follow OON appointment request process.

Illinois Medicaid
Follow OON appointment request process.

Arizona Medicaid
Follow OON appointment request process.

All other states not listed:
Follow OON appointment request process.

We just moved to Kansas or Missouri, but still have our former out-of-state Medicaid plan. What should we do?
Start by calling the state’s Medicaid plan where you moved from and let them know you have moved to a new state. Most likely, they will cancel/remove the coverage status for your child since he/she is no longer a resident of that state.

Once your out-of-state Medicaid plan has been canceled, contact a Children’s Mercy Financial Counselor at (816) 234-3567. They can help you apply for Missouri or Kansas Medicaid, and determine if you are eligible for other financial programs. Find more information on our Financial Counseling process page.

I live in a state other than Missouri or Kansas. Am I eligible for financial assistance through Children’s Mercy?
To review financial assistance guidelines and requirements, please visit the Financial Counseling process page.

Medical

 

  • PHCS Limited Benefit Plan

  • Prime Healthcare (Anthem Blue Cross)

  • Surest United Healthcare

Q: I've heard a lot about health care insurance changes. How do they affect me?

As part of the Affordable Care Act, all Americans must have health insurance as of 2014.

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

Options include:

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 – Dec. 15 annually, but you may enroll year-round if:

  • You qualify for or are renewing Medicaid (MO HealthNet or KanCare) coverage.
  • You are an American Indian/Alaska Native who is an enrolled member of a federally recognized Tribe or Alaska Native Corporation.
  • You are enrolling in the Small Business Health Options Program (SHOP).
  • You experience certain life events like:
    • Getting married
    • Having 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?
  • 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 always contact your insurance provider. You can also contact any number of navigators, whose services help ensure your family has adequate coverage. See list here.

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; the providers your insurance recommends; the timeframe for getting a response; or anything else about your health insurance. The DOI oversees the insurance industry and protects you as an insurance consumer.

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

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

Our hope is that all health 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 health plans?

Contact your employer or insurance provider 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.

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.

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 (hyperlink to new drawer for cost share)
  • 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.

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 10 specialties: Cancer, Cardiology & Heart Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery, Neonatology, Nephrology, Neurology & Neurosurgery, Orthopedics, Pulmonology, and Urology.
  • Children's Mercy received nursing's highest honor, Magnet Designation, from the American Nurses Credentialing Center for the fifth time in 2020.