Contact our billing office with questions: (888) 767-4550

We’ll Bill Your Insurance Company!

If Medicare or another health insurance plan is fully or partially responsible for your ambulance bill, we’ll make sure they pay for their portion.

Simply provide the information requested here and we’ll take care of the rest!

Patient Data

Patient Name

Insurance Information

Medicare

Medical Assistance

Commercial/Motor Vehicle/Workers Comp

Insurance Information
Insurance Company Name
Mailing address (if on card)
Phone Number (if on card)
Policy Holder Name
Policy Number
 
Billing Authorization
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.