Frequently Asked Questions: Understanding Health Care Costs
Thank you for choosing Children’s Mercy. Health care services are as unique as the patients and families we serve at Children’s Mercy, and health care pricing is complicated. We are committed to helping families understand and plan for health care expenses.
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 the patient’s 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 services that are needed.
- The patient’s specific health insurance plan, including deductible, co-insurance and copays.
Here is a list of common terms and definitions related to insurance and health care costs.
- If the patient does not have insurance:
- The patient and/or family may be eligible for a self-pay discount.
- The family may qualify for financial assistance.
- For more information about being uninsured, please see our Insurance Plans and Coverage Types Accepted page.
For most locations, Children’s Mercy bills as an outpatient hospital, not a private clinic. This helps to ensure our outpatient clinics are held to the same high standards of safety, outcomes, and oversight as our hospital.
Facility Fee Disclosure: Most Children’s Mercy locations are considered outpatient hospital-based clinics; these locations are billed with a separate facility fee that may result in higher out of pocket costs.
Locations that will have a facility fee:
|Adele Hall||Children’s Mercy Kansas|
|Children’s Mercy Northland||Children’s Mercy Blue Valley|
|Children’s Mercy East||Children’s Mercy at the University of Kansas|
|Children’s Mercy College Boulevard|
Locations that will not have a facility fee:
|Children’s Mercy Joplin||Children’s Mercy Junction City|
|Children’s Mercy St. Joseph||Children’s Mercy Outreach Great Bend|
|Children’s Mercy Topeka|
|Children’s Mercy Olathe|
|Children’s Mercy Outreach Garden City|
|Children’s Mercy Wichita|
|Children’s Mercy Sports Medicine Center at Village West|
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|
|Insurance Pays (80% of medical expenses based on plan selected)||$4,014.39|
|Patient/Family Pays (20% of medical expenses based on plan)||$1,003.60|
|Total Due from Patient/Family||$1,003.60|
Yes! We recommend all families contacting their insurance company to be informed of their benefits prior to their service.
Not sure what questions to ask?
Here are some suggestions on what question to ask when speaking to your insurance plan:
- Am I in-network with Children’s Mercy?
- Do I have coverage under my plan for the services my child needs at Children’s Mercy? You should let them know Children’s Mercy bills as an outpatient hospital.
- Is a referral or prior authorization required prior to service?
To comply with federal law, Children’s Mercy is providing the current list of our standard charges for Children’s Mercy Hospital and standard charges for Children’s Mercy Kansas for all items and services we offer.
Additionally Children’s Mercy has a Patient Estimate Tool available to help provide families with the potential out of pocket costs for 300 shoppable services. Get your estimate now!
Here is what you will need to obtain an estimated cost of services:
- The patient’s health insurance information (if applicable)
- The CPT code(s) or procedure code(s) and/or the description of the service associated with the care the patient will receive at Children’s Mercy.
Not sure what the codes or descriptions are?
Your child’s ordering provider or the Children’s Mercy clinic can help you with this information.
Each Children’s Mercy location may ask for a payment toward your expected out of pocket costs. Amounts may vary based on location and type of service.
Because Children’s Mercy bills as an outpatient hospital, your office visit and/or specialty copayment may not apply. Any payment requested will be applied toward your bill. For more information, see "How does Children’s Mercy bill?" above.
Information related to patients who are uninsured can be found on our Insurance Plans and Coverage Types page.
We encourage you to contact the Children’s Mercy Financial Counseling team. They can help both uninsured and underinsured patients and families apply for financial resources for services that are eligible.
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.
- Financial Resources and Billing Information
- Cost of Care Estimate Tool
- Insurance Plans and Coverage Types Accepted
- FAQ: Understanding Health Care Costs
- Update Insurance Card or Demographics
- Insurance Terms and Definitions
- Pay My Bill
- Financial Counseling
- El Seguro
- Comprendiendo los Costos de Atención Médica
- Medicaid Renewal Update
- No Surprises Act
- Ley de No Sorpresas
- Guarantor Change Request Form
- Billing Process
- Your Visit
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