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Insurance Plans and Coverage Types Accepted

Does your insurance plan
include Children's Mercy?


Navigating your family’s health insurance plan coverage can be complicated, especially with all options available. But one thing is simple: if you have a child, make sure your health plan includes Children’s Mercy.

Children’s Mercy contracts with many insurance plans and networks to provide health care services to their participants. Here, you will find a list of plans we contract with and accept.

Please note, participation with these plans is not a guarantee of payment or coverage. Many insurance plans require a referral or prior-authorization for coverage of certain services. It is important to check with your insurance plan to ensure your specific benefits include coverage for services at Children’s Mercy. If you have questions regarding your benefits and coverage, please contact your insurance plan directly.

In-Network

  • Aetna CVS Health
  • Anthem BCBS – Pathway & Pathway X (For services at MO locations only) 
  • BCBS of Kansas - BlueCare & Blue Choice 
  • BlueKC (BlueSelect Plus & Preferred Care Blue)
  • Medica (Medica with MU HealthCare & Select by Medica) 

Out-of-Network

  • Ambetter from Home State Health (Missouri) 
  • Ambetter from Sunflower Health Plan (Kansas)
  • Balance by Medica (offered in SW MO)
  • Blue KC BlueSelect
  • Cox Health EPO
  • Oscar Health
  • United Healthcare ACA Exchange (Gold, Silver, Bronze)
  • Well First by Medica (offered in St. Louis)

Commercial

  • Aetna
    • CareLink 
    • CVS Caremark
    • Meritain
  • American Healthcare Alliance
  • Anthem BCBS of Missouri (utilizing BlueKC network)
  • Ascension Health Plan (utilizing BlueKC network)
  • BlueKC
    • Blue Access (Out-of-Network)
    • BlueCard PPO (plans with PPO suitcase on ID card)
    • BlueSelect (Out-of-Network)
    • BlueSelect Plus
    • High Performance Network
    • Freedom
    • Freedom Network Select
    • Preferred Care
    • Preferred Care Blue
    • Preferred Health Professionals
  • BCBS of Kansas BlueChoice Solutions
  • Cigna
    • Cigna + Oscar
    • Cigna Plus
    • Cigna SureFit
    • Great-West Healthcare
    • HealthPartners
    • LocalPlus or LocalPlusIN
    • MVP Health Care
    • Network Open Access
    • Open Access Plus
    • PriorityHealth
    • Tufts Health Plan
  • Centivo Network
  • CoxHealth Network
  • CoxHealth Plans (utilizing First Health Network)
  • FAIROS (powered by OccuNet)
  • First Health Network
  • GEHA (utilizing UHC network)
  • HealthLink HMO & Open Access
  • HealthLink PPO (utilizing Freedom Network)
  • Humana
  • Medica
    • Balance by Medica (Out-of-Network)
    • Medica with MU Health Care (referral required)
    • Select by Medica
    • WellFirst by Medica (offered in St Louis Metro)
  • Mercy Health Springfield Communities
  • MultiPlan (excluding all health and/or cost sharing ministries)
  • National Preferred Provider Network
  • PHCS (excluding all health and/or cost sharing ministries)
  • ProviDRs Care (formerly WPPA)
  • QuikTrip
  • United Healthcare (UHC)
    • ACA Exchange [Gold, Silver, Bronze] (Out-of-Network)
    • All Savers
    • Custom Network Plan (Out-of-Network)
    • Deere Premier (Out-of-Network)
    • Surest (limited benefit coverage)
    • UHC Core Essential
    • UHC Choice & Choice Plus
    • UHC Navigate
    • UHC NexusACO
    • UHC Options
    • UHC Select
    • UMR
  • USA Managed Care Organization
  • WellFit Health

Federal Plans

Medicare Advantage (MA) Plans


As a pediatric health system, Children’s Mercy Kansas City does not contract or participate with any Medicare Advantage  plans.

State Medicaid 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.

Kansas and Missouri Medicaid Managed Plans

  • Kansas
    • Aetna Better Health 
      • SkyGen USA Dental
      • SkyGen USA Vision
    • Sunflower Health Plan
      • Envolve Dental
      • Envolve Vision
    • United Healthcare Community Plan of Kansas
      • SkyGen USA Dental
      • MARCH Vision Care 

  • Missouri
    • Healthy Blue of Missouri
      • DentaQuest
      • MARCH Vision Care
    • Home State Health/ Show Me Healthy Kids
      • Envolve Dental
      • Envolve Vision
    • United Healthcare Community Plan of Missouri
      • United Healthcare Dental
      • MARCH Vision Care

Specialty Networks


Mental and Behavioral Health

  • Cenpatico
  • Evernorth Behavioral Health (formerly Cigna Behavioral Health)
  • Lucet Behavioral Health (formerly New Directions)
  • Optum / United Behavioral Health

Centers of Excellence - Transplant Networks

  • Aetna Institutes of Excellence (IOE)
    • BMT, Heart, Kidney
  • Blue Distinction Centers for Transplant (BDCT)
    • BMT, Heart
  • Cigna LifeSOURCE Transplant Network Designated Programs
    • BMT, Kidney 
  • Humana National Transplant Network  
    • BMT, Kidney 
  • LifeTrac/Emerging Therapy Solutions (ETS) Programs of Excellence
    • BMT, Heart, Kidney,
  • Optum Pediatric Transplant Centers of Excellence (COE) Network
    • BMT, Heart, Kidney

Dental

  • Delta Dental
  • DentaQuest 
  • Envolve Dental
  • MetLife
  • SkyGen USA (formerly Scion Dental)

Vision

  • Envolve Vision/Opticare
  • MARCH Vision Care
  • SkyGen USA (formerly Ocular Benefits)
  • Vision Service Plan (VSP)

A narrow network is a type of health plan that requires members to receive care in their preferred, narrow network of a select group of doctors, hospitals, outpatient facilities, laboratories, etc.

  • Aetna KC Care Network Plus (formerly I-35 Preferred)
    • Adult Health System Network: AdventHealth Shawnee Mission, KU Medical Center, Liberty Hospital, HCA MidWest Health, North Kansas City Hospital, Olathe Health, University Health
  • Aetna Connected
    • Adult Health System Network: AdventHealth Shawnee Mission, KU Medical Center, Liberty Hospital, HCA MidWest Health, North Kansas City Hospital, Olathe Health, University Health
  • BlueKC High Performance Network
    • Adult Health System Network: Saint Luke’s Health System
  • Cigna Sure Fit
    • Adult Health System Network: HCA MidWest Health, North Kansas City Hospital
  •  Cigna Local Plus
    • Adult Health System Network: HCA MidWest Health, North Kansas City Hospital
  • UHC Core Essential
    • Adult Health System Network: Saint Luke’s Health System

Medical

  • Ambetter from HomeState Health Plan (Missouri)
  • Ambetter from Sunflower Health Plan (Kansas)
  • Anthem Pathway/Pathway X (KS locations only)
  • Arkansas Medicaid Provider-Led Arkansas Shared Savings Entity (PASSE) 
    • Arkansas Total Care
    • CareSource
    • Empower Healthcare Solutions
    • Summit Community Care
  • Ascension Personalized Care EPO
  • Aspen STM (All Hospital/Facility Services)
  • Balance by Medica
  • BlueKC Blue Access 
  • BlueKC Blue Select
  • Cox Health EPO
  • Custom Network Plans (Administered by United Healthcare)
    • Custom Network Plan
    • Deere Premier
  • HealthChoice of Oklahoma 
  • Kaiser Permanente
  • LifeShield STM (All Hospital/Facility Services)
  • MedBen
  • Mercy Anthem Alliance EPO (Anthem BCBS) 
  • Oklahoma Medicaid SoonerSelect (Managed Medicaid plans Only)
    • Aetna Better Health of Oklahoma
    • Humana Healthy Horizon
    • Oklahoma Complete Health
  • Oscar Health
  • PHCS Practitioners Only (All Hospital/Facility Services)
  • Preferred CommunityChoice
  • Prime Health Services (PHS)
  • United Healthcare ACA Exchange [Gold, Silver, Bronze]
  • US Health and Life Vālenz Health - Ascension Personalized Care (offered in Wichita market)
  • Walmart / Mercy: Arkansas Local Plan & Southwest Missouri Local Plan
  • Well First by Medica (offered in St. Louis)
  • All other Medicaid and Managed Medicaid plans outside of the states of Arkansas, Kansas, Missouri, and Oklahoma.

Mental and Behavioral Health

  • Beacon Health Options (formerly Value Options)
  • Magellan Healthcare
  • Mercy Managed Behavioral Health

Dental

  • Oklahoma Medicaid SoonerSelect Dental Plans
    • DentaQuest
    • LIBERTY Dental
  • United Concordia Dental

Home Care

  • Humana

Therapy

  • TheraMatrix (BCBS of Michigan)

Vision

  • EyeMed
  • Vision Care Direct

The No Surprises Act defines an uninsured individual as:

  • A patient who has no insurance and is self-pay.
  • A patient who has a short-term medical plan.
  • A patient who has a cost share or ministries sharing group coverage.
  • A patient who has a limited benefits plan.

What is a cost or health care sharing plan?
A cost share or health care sharing plan is provided by organizations whose members “share” medical costs. As part of a health care sharing plan, you are responsible for paying certain share amount each month (like a premium) as well as an “annual unshared amount” for your own expenses (like a deductible) that your medical expenses must exceed before the plan shares your expenses. 

Does Children’s Mercy accept cost sharing plans?
Per the No Surprises Act, individuals with a cost share or health care share plan are uninsured. Therefore, any patient who is enrolled in a sharing plan will be identified as self-pay, or uninsured, when seeking care at Children’s Mercy. Within three days of your appointment being scheduled, a member of Children’s Mercy’s Financial Clearance team will call you to provide a good faith estimate for services the child may receive as part of the scheduled appointment.  

How does billing work if I have a cost share plan?
You will receive a statement for services received with the appropriate self-pay discount already applied. You may forward your statement to your cost share group for review and reimbursement, but you are ultimately responsible for payment regardless of whether your cost share group reimburses you or not. Please note, Children’s Mercy will not send a claim or statement to the cost share group directly; it is your responsibility to submit to your cost share group.

The No Surprises Act defines an uninsured individual as:

  • A patient who has no insurance and is self-pay
  • A patient who has a short-term medical plan
  • A patient who has a cost share or ministries sharing group coverage
  • A patient who has a limited benefits plan

Can my child be scheduled for an appointment if they do not have insurance?

Yes! Within three days of your appointment being scheduled, a member of the Children’s Mercy’s Financial Clearance team will call you with a good faith estimate for the services the child may receive as part of the scheduled appointment.

If my child does not have insurance, how can they get coverage?

  • You can enroll in the health care exchange during the open enrollment period, or if you meet the definition of a life event at healthcare.gov.  
  • Review the information on this page to confirm what exchange plans are in-network with Children’s Mercy
  • You can contact a Children’s Mercy Financial Counselor for help enrolling/applying for insurance. A counselor can also screen you for one of Children’s Mercy’s financial aid programs.

How much will I owe if my child does not have insurance?

Families who are defined as uninsured will be eligible for the self-pay discounted rate. You can run a patient estimate for services that your child may receive.

If your insurance card references any of the terms listed below, you likely have limited coverage at Children’s Mercy for the services your child may need

  • Practitioner Only
  • Ancillary Services
  • Hospital/Facility Based Charges
  • Referenced Based Pricing or Accepting Medicare Rates

Typically, these plans will only cover the office visit with a doctor or nurse practitioner, but no additional services outside of meeting with the provider.  Children’s Mercy bills as an outpatient hospital, which means that services are most likely not covered at all, or have very limited coverage. To avoid paying higher out-of-pocket costs, contact your health plan to ask where you child can receive care that will be covered by your insurance plan. If there is not another provider that your plan will cover, ask your plan how you can seek approval to have these services at Children’s Mercy.

To ensure your child’s services will be covered by your insurance plan, follow the OON Appointment Request process.

Examples of Hospital Based Charges that will most likely not covered by a Practitioner Only plan:


Diagnostic testing:
Any lab, radiology, blood/urine/saliva lab, genetic testing, X-rays, ultrasounds, CT/MRI’s, IVR’s PET scans, nuclear medicine studies, echocardiograms, sleep studies, EEG’s, allergy testing, and/or development, behavioral, or psychology testing

Therapy services: New/established patient evaluations or therapy/services with a physical therapist, occupational therapist, speech therapist, audiologist, or development/behavioral or psychological services

Medications: Including but not limited to oral, injected, infused medications or implants

In-office or surgical procedures: Circumcisions, bone/fracture care, laser procedures, colonoscopies, or any services in an operating room, procedure room, or in a clinic

Facility charges: including Inpatient or Observation stay, and ground/air ambulance

*This list is not an all-inclusive list. Please email  NarrowNetwork@cmh.edu for questions related to specific services.

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 760 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 50 areas of specialties, many of which are only offered in the Kansas City metro by pediatric subspecialists at Children's Mercy.
  • Children's Mercy is recognized as one of the top children's hospitals by U.S. News and World Report, ranking in 11 specialties. Notably, eight of these specialties are ranked among the top 20 nationally. Ranked specialties include: Cardiology & Heart Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery, Neonatology, Nephrology/Kidney, Neurology & Neurosurgery, Orthopedics, Pulmonology & Lung Surgery, and Urology.
  • Children's Mercy has received nursing's highest honor, Magnet Designation, from the American Nurses Credentialing Center five consecutive times.