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Understanding Health Care Costs

Health care services are as unique as the patients and families we serve at Children’s Mercy, therefore how much a family may owe varies greatly. Health care pricing is complicated, but we are committed to helping families understand how much they may owe when they come to Children’s Mercy.

What are some of the things that could impact how much I owe?

Besides individualized care, there are several factors that determine what a family will pay for health care at Children’s Mercy, including:

If the patient has insurance:

  • The negotiated price for services our hospital has with their insurance company.

  • Whether the patient’s insurance plan is in or out of network with Children’s Mercy.

  • Whether the patient’s insurance plan covers the services that are needed.

  • The family’s specific health insurance plan, including deductible, co-insurance and copays.

If the patient does not have insurance:

  • The family may be eligible for a self-pay discount.

  • The family may qualify for financial assistance.


Real-life example of charge price vs. patient responsibility cost

Due to the variables mentioned above (and as illustrated in the example below), our standard charges do not reflect the actual amount you will owe.

Here is an example of an insurance claim for a two-year-old referred by her pediatrician to Children’s Mercy for an outpatient diagnostic test to evaluate stomach pain and weight loss. (This serves only as an example to show what a family actually pays is a fraction of the standard charge amount.)

Example of charges before and after insurance is applied

Billed Standard Charges $7,719.98
Children's Mercy Discount to Insurance Company $2,701.99
Total Due $5,017.99
Insurance Pays (80% of medical expenses based on plan selected) $4,014.39
Patient/Family Deductible  $0
Patient/Family Pays (20% of medical expenses based on plan) $1,003.60
Total Due from Patient/Family $1,003.60

 

Pediatrics is different

Kids are unique! Medical care for kids generally requires specialized skills, technology, and resources. This is especially true for dedicated children’s hospitals, who offer a lower staff to patient ratio, technology, and equipment specially designed and sized to accommodate a two-pound baby in the NICU and a 17-year-old cancer patient. Specialized services like Child Life, low-dose radiation, pharmacists that understand the nuances of medicine dosing for every age, and staff with a higher level of specialization all contribute to the individualized services needed.

This level and complexity of care simply costs more than it does in adult hospitals or free-standing facilities that don’t have to accommodate for these variables or reflect the unique needs of this patient population. These specialized services and equipment are why Children’s Mercy has better pediatric outcomes and is consistently recognized for those outcomes by institutions like U.S. News & World Report.

But let our patients tell you why we are different:

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How can I find out how much I might owe?

Our goal is to provide families with not only a list of our charges but also an accurate understanding of their anticipated financial responsibility.

To comply with federal law, Children’s Mercy is providing the current list of our standard charges for all items and services we offer as well as a list of our standard charges for 300 shoppable services we customarily provide. Shoppable services are those that can be scheduled in advance.

If you have insurance, consider calling your insurance company. Because our standard charges do not reflect the actual amount you will owe, we suggest calling your insurance for more information. Here are some questions you can ask your insurance:

  • Are you in-network with Children’s Mercy?
  • Do I have coverage under my plan for the services my child needs at Children’s Mercy?
  • What will my estimated out of pocket responsibility be (this may include deductibles, copays or co-insurance)?
    • In order for your insurance to provide you an estimate, you will need to know the CPT or procedure code(s) associated with the care your child will receive. You can obtain this from your child’s doctor or medical clinic.
    • You should inform your insurance that Children’s Mercy bills as an outpatient hospital.
  • Is a referral or prior authorization required prior to the service?

What if I am unsure how much I may owe after calling my insurance?

Children’s Mercy wants to help! The Financial Clearance team can provide you a price estimate based on your child's scheduled appointment information and insurance plan. You will need to know the CPT or procedure code(s) associated with the care your child will receive at Children’s Mercy for an accurate price estimate. Please allow 3-5 business days for estimates to be returned. Click here to request a price estimate.

*Please note price estimates provided by Children’s Mercy are only estimates. The actual price owed may change based on the patient’s health or other factors which may impact the type, length or intensity of care required. If you require a same-day service estimate, please call Financial Clearance for same-day service quotes.

What if I do not have insurance or I am afraid I will not be able to afford how much the service will be?

We would encourage you to contact the Children’s Mercy Financial Counseling team. They help both the uninsured and underinsured apply for financial resources for families and services that are eligible. 

What if I am not eligible for any of the financial resources?

If you do not qualify for any of the financial resources, you may call Customer Service after you receive your bill to set up an interest-free payment plan. Learn more about paying your bill.

Still have questions?

Contact us for more information about payment, billing, insurance and more.

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