Insurance

We accept most major insurance plans and over 200 smaller plans. Call your insurance provider to see if Pediatric Partners is on your plan.

Plans we do not accept:

We do not take any Missouri Medicaid or Medicare plans.

As of July 1, 2022, we do not accept

  • Ambetter from Sunflower Health
  • Balance by Medica
  • BCBS Blue Select from the Health Insurance Marketplace*
  • Christian Care Medi-Share
  • Champ VA
  • CoxHealth
  • Oscar Health
  • US Health & Life
  • UHC (United Healthcare) exchange plans *

*We do accept other BCBS and UHC plans, just not the listed marketplace plans from those companies.

Want to estimate your fees?



If you would like a list of our charges and the associated insurance codes, please send an email request to office@pediatricpartnerskc.com. Our office managers and billing manager have come up with a handout with all the most used codes and their charges. You can use this information to contact your insurance company before a visit to estimate how much your portion of the charge will be.

We cannot publicly post this handout due to federal regulations, but we are happy to share it through our portal or in the office.

We can only give our charges, we cannot determine how your insurance will adjust it or how much they will cover versus how much you will be responsible for. 

Understanding Your Insurance Plan


Many parents of our patients have questions regarding their insurance coverage of certain services. Our office accepts many plans; each is underwritten between a person’s employer and the insurance company, so even two Coventry contracts might be different. We are unable to know every patient’s specific plan.

Most insurance companies today share costs with the patient. There are many cost sharing options for you to choose, and we abide by the billing, coding, and collections set forth by your plan.

  • Formulary Information:

    It is often important to learn the formulary drug status when choosing a medication to keep your costs low. 


    Our office receives many requests to change a prescription due to insurance cost, but usually we do not know what the preferred medication is. The insurance company provides its members with a formulary, usually available online to its customers but not to the general public (or doctors).


    We cannot prescribe the cheapest medicine unless we know what your formulary is. That requires you to look up the medicines on the formulary. You will need to access your insurance company's website private portal to look up this information.



  • Deductible:

    The total amount of covered medical expenses that must be paid by the patient before the insurance company begins paying benefits. After this requirement is reached, the insurer will begin paying according to terms of the contract — often 75-85% of covered medical costs. The patient is responsible for any remaining balance.

  • Flat-rate copayment:

    The patient pays a share of covered medical costs and the insurance carrier pays an amount based on the policy. For example, when the patient pays $15 of any office visit charge or $3 for any prescription, the insurance carrier is responsible for the balance.

  • Percentage-based copayment:

    The patient pays a percentage share of covered medical costs and the insurance company pays an amount based on the patient's policy. Examples: 20% of the office visit charge would be $10 of a $50 charge, $12 of a $60 charge, etc. Typically this copayment arrangement includes a deductible and may have other variations.


  • Consumer-driven health plans (CDHPs):

    CDHPs are the fastest growing plan type currently across the county. Employers are shifting financial responsibility to their employees by offering health plans with high deductibles and coinsurance to reduce cost to the business. Most of these plans cover wellness services such as immunizations, well-child visits, and periodic check-ups more than sick services. They usually have a high deductible, but when the deductible is met, the plan pays for services at a percentage (such as 80%) of a defined reasonable and customary fee schedule.

  • Health savings accounts (HSAs):

    HSAs are tax-favored savings accounts funded with pretax dollars by the individual or the employer. Money can be withdrawn from the account at any time with no penalty or taxes to pay for qualified medical expenses. An HSA can be established only along with high-deductible health insurance plans that meet Internal Revenue Service rules that set the amount of the individual and family deductible. The amount an employee can put in an HSA is capped at the amount of his or her annual deductible of his or her health insurance policy. Any unused funds each year remain in the account, accumulate tax-free and can be used for future medical expenses.

  • Health reimbursement accounts (HRAs):

    HRAs are funded by the employer and can be used by an employee as pretax dollars. These accounts can be set up independent of any specific health plan or benefit design. Money can be used to pay for medical expenses. HRA funds can also be carried over from year to year. The amount of the contributions to the HRA varies based on the employer. The employer owns the fund and any unused amounts may or may not be transferred on termination of employment, depending on the terms of the fund. Medical spending accounts (MSAs) and flexible spending accounts (FSAs) are versions of HRAs with particular features.

Understand the fine print of your plan



Your health insurance policy is an agreement between you and your insurance company. It is generally negotiated by your employer if it is an employee benefit. The policy lists a package of medical benefits such as tests, medications, and treatment services. The insurance company agrees to cover the cost of certain benefits listed in your policy. These are called "covered services." Coverage does not guarantee full payment and your insurance company may require partial coverage by the policyholder. Your policy also lists the kinds of services that are not covered by your insurance company. You have to pay for any uncovered medical care that you receive.

Be aware that a medical necessity is not the same as a medical benefit. A medical necessity is something that your provider has decided is necessary based on clinical presentation and standard of care. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your provider might decide that you need medical care that is not covered by your insurance policy. Common examples of this might be a splint for a sprain or a spacer device to use with an inhaler for wheezing.

  • Helpful Tips:

    Since we are unable to know the specifics of every insurance plan, we encourage families to understand their own coverage. One would never buy a car without test driving several makes/models and making an informed choice. On the same token, we encourage families to read their insurance information to make an informed decision of which plan to choose (if more than one is offered by the employer). By understanding your insurance coverage, you can help your doctor recommend medical care that is covered in your plan.

    • Take the time to read your insurance policy. It's better to know what your insurance company will pay for before you receive a service, get a lab or x-ray, or fill a prescription.
    • Some medications, tests or hospitalizations may have to be approved by your insurance company before your doctor can provide them. Our office will charge if the prior authorization takes a significant amount of nursing time, but not if it is a simple form to fax.
    • If you still have questions about your coverage, call your insurance company and ask a representative to explain it.
    • Remember that your insurance company, not your provider or the physician's office, makes decisions about what will be paid for and what will not.
  • Vaccines for Children (Medicaid and no insurance)

    Children without insurance and those with Medicaid insurance can get vaccines from the Vaccines For Children (VFC) program. Learn more here.

Frequently Asked Questions (FAQs):

Why am I charged at a well visit?
Why does the front desk always ask for my card?
How do I know what medicines will be least expensive?
What if I have a question about a bill?
What do I do if I received a bill that I don’t think I should have to pay?
How can I help my insurance company begin to cover costs of currently allowable but not covered bene

Key Insurance Terms:

  • Billing Statement:

    A summary of current activity on an account.

  • Birthday Rule:

    To determine which parent carries primary insurance and which will be secondary if both parents will cover insurance, a birthday rule is generally accepted. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor — not the year — so it doesn't matter which spouse is older. Like most rules, the birthday rule has exceptions:

    • If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children.
    • If one spouse is currently employed and has health insurance through a current employer, and the other spouse has coverage through a former employer (e.g., through COBRA), the plan belonging to the currently employed spouse would be primary.
    • In the event of divorce or separation, the plan of the parent with custody generally provides primary coverage. If the custodial parent remarries, the new spouse's coverage becomes secondary. And finally, the non-custodial parent's plan would provide a third layer of insurance protection. This order of payment can be altered by a court-issued divorce decree or by agreement, but the insurance companies must be notified.
  • Claim:

    Information billed to the insurance company for services provided.


  • Co-payment or Co-Insurance:

    The balance due by the policyholder as determined by the insurance company.

  • Deductible:

    Amount the policyholder needs to pay for covered health services before a health plan will begin to pay benefits. Usually a new deductible is met each calendar year.

  • EOB (Explanation of Benefits):

    A detailed explanation from the insurance company that identifies the amount due for services provided. This includes any payments made by the insurance company and any listed co-payment, coinsurance, or deductible due from the policyholder.


  • Guarantor:

    The person responsible for paying the bill.


  • Payment Arrangements:

    A formal payment plan set up between a patient and our office when payment cannot be made in full.


  • Primary Insurance:

    Designation given to the insurer that your claim will be submitted to first, for payment of services you received. For dependent children, the primary insurance is the parent with the first birthday of the calendar year. For example, if Dad’s birthday is July 1972 and Mom’s is January 1973, Mom’s birthday is first and would be the primary insurance. See also "Birthday Rule".

  • Prior Authorization/Pre-Certification:

    A formal approval obtained from the insurance company prior to delivery of medical services. Many insurance companies require prior authorization or pre-certification for specific medical services, procedures or medications.

  • Subscriber:

    The person who holds and/or is responsible for the medical insurance policy.


  • Secondary Insurance:

    Designation given to the insurer that your claim will be submitted to second, for payment of services you received. See also "Birthday Rule."