What if I have anout-of-network plan?

Children's Mercy recommends following the steps outlined below to ensure you can make the most of your insurance benefits and help lower your financial out-of-pocket costs.


Step 1: Review the List of Insurance Plans

Take a moment to review the list of plans that have chosen to include Children’s Mercy in their network.

Step 2: Call Your Insurance

If you do not see your insurance listed, call your insurance and ask what providers are available in your coverage network.

Step 3: Seek care in your coverage network

To avoid higher out-of-pocket costs for your child's services, it is best to seek treatment with the health care providers approved by your insurance plan or specific coverage network.

Step 4: Request an Out of Network Exception for your child to be seen at Children’s Mercy

If your insurance says there are no providers in your network that can perform the service, please ask your insurance how to request an exception approval for your child to receive services for each individual out of network provider/service. Once they have provided you with the exception approval(s) please request a call reference number for the call. Make sure to write this information down.

Step 5: Fill out the out of network request form with the exception information

Take the exception approval information

Step 6: What to expect after you submit the form

Once you have completed and submitted the form, the Children's Mercy Financial Clearance team will review your request. Requests that have completed all steps above will be initiated with your insurance. Initial requests may take up to 30 days to be completed. If your insurance approves and completes all required authorization and reimbursement processes for you to be seen at Children’s Mercy, you will be contacted by a scheduler to set up your appointment. If your insurance denies the request, a member of the Financial Clearance team will contact you to discuss next steps.

Please note: Requests that have not completed the steps outlined above will be placed on a 2 week hold. A member of the Financial Clearance team will call to notify you that your request has been placed on hold due to missing required information (such as the call reference number from your contact with the insurance plan). If required information is not obtained within 2 weeks, your request form will need to be resubmitted with all required fields.

Out-Of-Network Exception Form »

If you believe you may already have an exception in place with your insurance, please email the Financial Clearance team at NarrowNetwork@cmh.edu for more information.

What if my insurance does not approve the exception request?

If the Children’s Mercy Out of Network exception request is denied by your insurance, and you would like to continue with your child being seen at Children’s Mercy you may be able to continue as a self-pay (no insurance) patient. A Financial Clearance Specialist will walk you through this process when you are notified of the exception denial. The Financial Clearance Specialist will be able to provide the estimated price that you will be asked to pay in full prior to scheduling as a self-pay patient. This option is only available after all steps above have been followed and the insurance has denied the exception request. For more information, please email NarrowNetwork@cmh.edu.