Skip to main content

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.

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:

Missouri

Kansas
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:

Missouri

Kansas
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
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

 

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.

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

Financial Resources and Billing menu