Step 1: Fill out the CM Out-of-Network Appointment Request Form
Now that you have received a preliminary decision from your insurance plan, it’s time to request an approval with Children’s Mercy by filling out this form. Requesting appointment approval ensures the services your child needs will be prior-authorized and paid appropriately Obtaining a Single Case Agreement (SCA) allows your child to be scheduled. If your child’s insurance denied your request, this form is also used to provide you with a patient price estimate for services at Children’s Mercy without an approval from your plan.
Step 2: Children’s Mercy Financial Clearance team will process your request
Once you have completed and submitted the form, a member of the Children's Mercy Financial Clearance team will contact your insurance and request any prior authorizations that may be needed. Once the prior authorizations have been approved, we will initiate a Single Case Agreement (SCA) with your out-of-network plan. This process can take up to 30 days to complete.
Step 3: Financial Clearance will contact you to review insurance decision and to discuss next steps
If OON plan approves the terms of the Single Case Agreement request:
If your insurance approves for you to be seen at Children’s Mercy, you will be contacted by a member of the Financial Clearance team; you may proceed with scheduling appointment.
If OON plan does not approve the terms of the Single Case Agreement request:
If your insurance denies your request to be seen at Children’s Mercy, you may be able to continue as a self-pay (no insurance) patient. A Financial Clearance Specialist will walk you through this process after you fill out the Out of Network Request form mentioned in Step 3 above with the denial information, including providing you the estimated cost and payment requirements. Once you agree to the payment requirements, the Financial Clearance team member will transfer you to scheduling.