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Insurance

Does your insurance plan
include Children's Mercy?


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 plan includes Children's Mercy.

Covered services and programs vary by insurance plan and employer. It is important to check with your insurance plan to ensure your specific benefits include coverage for services at Children's Mercy. Should you have questions regarding your insurance benefits and coverage, please contact your insurance carrier directly.

Commercial

 

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

Managed Medicaid Plans - Missouri

Specialty Networks


Behavioral Health (Outpatient)

Specialty Centers of Excellence - Transplant Networks

Dental

Vision

 

Medical

 

  • Bind On-Demand Health Insurance

  • PHCS Limited Benefit Plan

  • Prime Healthcare (Anthem Blue Cross)

Medical

  • Ambetter from HomeState Health Plan (MO)

  • Ambetter from Sunflower Health Plan (KS)

  • Anthem Pathway/Pathway X (KS locations only)

  • Blue Access (BCBS of Kansas City)

  • Blue Select (BCBS of Kansas City)

  • Cox Health EPO

  • HealthChoice of Oklahoma 

  • HealthPartners at UnityPoint Health

  • Kaiser Permanente

  • Mercy Anthem Alliance EPO (Anthem BCBS) 

  • Oscar Health

  • PHCS Practitioners Only (All Hospital/Facility Services)

  • Preferred CommunityChoice

  • Walmart / Mercy Arkansas Local Plan

  • WPPA ProviDRs Care Employer Network Design - City of Pittsburg (All Hospital/Facility Services)

  • All Medicaid and managed Medicaid plans outside of the states of Arkansas, Kansas, Missouri and Oklahoma unless mentioned above

Behavioral Health

  • Beacon Health Options (formerly Value Options)

  • Magellan Healthcare

  • Mercy Managed Behavioral Health

Dental

  • Envolve Dental

  • Liberty Dental

Home Care

  • CareCentrix

  • Humana

Therapy

  • TheraMatrix (BCBS of Michigan)

Vision

  • EyeMed

  • March Vision Care

  • Skygen USA Vision

Q: I've heard a lot about healthcare 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 (called narrow networks) 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.

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 750 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 and heart surgery, diabetes and endocrinology, gastroenterology, neonatology, nephrology, neurology and neurosurgery, orthopaedics, pulmonology and urology
  • 89 of the 90 Best Doctors in a pediatric subspecialty are from Children's Mercy according to the Kansas City Business Journal's 2015 Best Doctors®
  • Of the 92 pediatric subspecialists listed in 435 South 2015 Best Doctors, 91 are from Children's Mercy.
  • Children's Mercy was the first hospital in Missouri and Kansas designated a Magnet® organization, nursing's highest honor from the American Nurses Credentialing Center