Preguntas frecuentes

Consider these questions and answers when selecting your healthcare plan

Q: I've heard a lot about healthcare insurance changes. How do they affect me?
As part of the Affordable Care Act, all Americans must have health insurance as of 2014.
Q: What are the options for purchasing health insurance for my child?
Options include:
  • Get it through your employer.
  • Buy it on the Health Insurance Exchange at
  • Buy it from an insurance company, agent or broker.
  • Apply for Missouri or Kansas Medicaid. Click here for Missouri or here for Kansas.
Q: What is a Health Insurance Exchange?
Since all Americans are now required to have health insurance, the Health Insurance Marketplace at was designed to meet that requirement. The Marketplace (also called an Exchange) is a one-stop shop to find, compare and buy private health insurance options.

Neither Missouri nor Kansas have their own state exchange, so you'll find your options on the federal Health Insurance Marketplace at The next open enrollment (enrollment for anyone) starts Nov. 1, 2017 and ends Dec. 15, 2017.
Q: When can I enroll/when is open enrollment for insurance coverage on the Health Insurance Marketplace ( Can I enroll outside open enrollment time period?
Open enrollment (enrollment for anyone) is Nov. 1, 2018 – Dec. 15, 2018. But, you may enroll year-round if:
  • You qualify for or are renewing Medicaid (MO HealthNet or KanCare) coverage.
  • You are an American Indian/Alaska Native who is an enrolled member of a federally recognized Tribe or Alaska Native Corporation.
  • You are enrolling in the Small Business Health Options Program (SHOP).
  • You experience certain life events like:
    • Getting married
    • Having a child
    • Moving to a new area
    • Losing health coverage
    These may qualify you for a special enrollment period. You can see if you qualify for any of these at
More details and updated dates available at
Q: My child is a patient at Children's Mercy, or I want my child to be seen at Children's Mercy in the future. What do I need to know about my health insurance coverage?
It depends on what type of insurance you have for your child. Do you have coverage through one of the following plan types:

Exchange plans
If you buy health insurance on the Health Insurance Marketplace that covers your child, Children's Mercy is currently not covered by all of the plans.

Planes con cobertura limitada:

Planes médicos

  • PHCS Limited Benefit Plan
  • Prime Healthcare (Anthem Blue Cross)

Planes que actualmente no tienen contrato con Children's Mercy:

Planes médicos

  • Ambetter from Home State Health Plan (Missouri)
  • Ambetter from Sunflower Health Plan (Kansas)
  • Anthem Pathway/Pathway X (centros ubicados en Kansas únicamente)
  • BCBS of Kansas BlueChoice Solutions (JO/WY county KS locations and all MO locations)
  • Blue Access (BCBS of Kansas City)
  • Blue Select (BCBS of Kansas City)
  • HealthChoice of Oklahoma
  • HealthPartners UnityPoint Health
  • Mercy Anthem Alliance EPO (Anthem BCBS)
  • Orscheln Industries con HealthSCOPE
  • Oscar Health
  • PHCS Practitioners Only (All Hospital/Facility Services)
  • Preferred CommunityChoice
  • WPPA ProviDRs Care Employer Network Design (All Hospital/Facility Services)
  • Todos los planes de Medicaid, incluidos aquellos de atención controlada, fuera de los estados de Arkansas, Kansas, Missouri y Oklahoma

Planes de salud conductual

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

Planes odontológicos

  • Envolve Dental

    Planes de atención domiciliaria

    • CareCentrix
    • Humana

    Planes de terapia

    • TheraMatrix (BCBS of Michigan)

    Planes oftalmológicos

    • EyeMed
    • March Vision Care
    • Skygen USA Vision

    Other insurance plans (outside of Exchange or through your employer)

    When choosing any plan, even a plan purchased through your employer or outside of the Exchange, you should always make sure Children's Mercy is an in-network provider so that your child can continue care or get care here in the future. See the full list of all plans that include Children's Mercy.

    Those plans that exclude essential providers like Children's Mercy (called narrow networks) have two deductibles: One for services at in-network providers and one for services at out-of-network providers. Out-of-pocket costs could be higher if your child visits a provider who is out-of-network with your insurance plan.

    Q: What should I consider when comparing health insurance?
    When comparing, consider these things:
    • What is covered?
    • What is my monthly cost?
    • What is my deductible?
    • What is my coinsurance and copay?
    • Which providers can I see with this plan?
    • Annual out-of-pocket maximum for in-network services and annual out-of-pocket maximum for out-of-network services?
    Q: How do I know or how do I make sure Children's Mercy is included in my plan?
    You can always contact your insurance provider. You can also contact any number of navigators, whose services help ensure your family has adequate coverage. See list here.
    Q: What can I do if my insurance plan doesn't cover Children's Mercy, I was denied coverage or I am unhappy with my insurance?
    You are the best advocate for your child. We encourage you to call the Department of Insurance (DOI) with concerns; the providers your insurance recommends; the timeframe for getting a response; or anything else about your health insurance. The DOI oversees the insurance industry and protects you as an insurance consumer.
    Q: Why is Children's Mercy not a provider on all plans?
    We continue to negotiate with insurance companies. Despite our best efforts, we have found that some companies have chosen not to contract with us.

    Our hope is that all health insurance plans will cover Children's Mercy, especially since many services are not provided elsewhere in the region, so we can serve your child and all children in Kansas and Missouri.
    Q: Is there anything I can do to help ensure Children's Mercy is included in health plans?
    Contact your employer or insurance provider and tell them you think Children's Mercy is an essential provider for any health plan network.
    Q: I'm an adult patient at Children's Mercy. How do I get coverage?
    Please contact our financial counselors at (866) 572-0157 and they can help.
    Q: What if my child is seen at Children's Mercy and does not have insurance?
    Please contact our financial counselors at (866) 572-0157 and they can help.