Frequently Asked Questions: Understanding Health Care Costs

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:

Locations that will not have a facility fee:

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

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?

Children’s Mercy Kansas City

Disclaimer: In compliance with federal price transparency requirements, the information provided is a comprehensive machine-readable list of standard charges for all items and services provided by Children's Mercy at our hospital-based locations and is current as of the date posted. The charges listed are not a guarantee of the amount to be charged and do not typically reflect what you will owe. The actual cost will depend on the services and treatment provided as well as insurance considerations and may be different from the charges published. Standard charges are estimates only and are updated throughout the year so may differ from what is published. In addition, some items or services may have other associated variable costs or be billed separately. The pricing for some payors or some components of care may be blank.

If the patient has insurance, we encourage you to contact the insurance company to confirm individual payment responsibilities (including deductibles, co-pays, co-insurance, and out-of-pocket maximums) or what you may owe.  Contact us if you have additional questions or wish to learn about financial assistance.  

Missouri locations

Our hospital-based locations in Missouri include: Children's Mercy Adele Hall Campus, Children's Mercy Broadway, Children's Mercy East, Children's Mercy Northland and The Don Chisholm Center.

By downloading the file linked below you are acknowledging you have read and accept the disclaimer posted above. 

Children's Mercy Missouri Locations Standard Charges 

Kansas locations

Our hospital-based locations in Kansas include: Children's Mercy Hospital Kansas, Children's Mercy Blue Valley and Children's Mercy College Boulevard.

By downloading the file linked below you are acknowledging you have read and accept the disclaimer posted above. 

Children's Mercy Kansas Locations Standard Charges 

Patient Estimate Tool

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.