Sample Fire District


EMS Billing Services

(800) 238-9398

P.O. Box 3510

Silverdale, WA 98383

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Welcome


Dear Patient,
Thank you for visiting our Emergency Medical Services web site. The statement you have received is for an ambulance transport provided to you or a family member by Sample Fire District. You may find the following information helpful.

Insurance Information


Please check your invoice/statement for an IMPORTANT MESSAGE section at the top. If we do not have insurance information, or if we need a signature, a request was included with your statement.

If we have insurance information, the insurance company has been billed and the statement reflects any remaining balance that may be due.

If there is any other insurance that can be billed, please provide us with that information. You may download and fill out the insurance information form to the right and mail, fax or email a scanned copy of it to the billing service department.

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Levy Information


If you live within East Pierce Fire & Rescue boundaries, then, after all insurance(s) have been billed, any balance not covered by your insurance will be paid out of EMS Levy funds. If you are a resident and have no insurance coverage, the EMS Levy will cover your bill. You will continue to receive statements until you have provided us with your insurance information, or you have verified that you have no coverage.

If you live outside of East Pierce Fire & Rescue boundaries, you are financially responsible for any portion of your bill not paid by your insurance(s). If you are not a resident and you are uninsured, you are responsible for the total amount of your bill.

If you live within East Pierce Fire & Rescue boundaries, then you are considered a resident and there will be a levy message on your billing statement. If you do not see a levy message on your billing statement, this means that you are not considered a resident for ambulance billing purposes.

 

Financial Assistance


Financial Assistance is available to those who are eligible. If you or your family's annual income is at or below the national poverty guidelines for this area, an application may be downloaded using the link to the right.

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Payment Options


Credit Card/ACH transaction
A processing fee will apply when making payments by credit card or ACH transaction. For credit cards, the fee is 2.95% of the invoice amount (Minimum Transaction Amount: $2.00). For ACH transactions, the fee is $0.85.
(NOTE:  You will be asked for information appearing on your invoice/statement, so it should be readily available. Verify that Sample Fire District appears in the upper left corner of your invoice/statement.)
    -  ONLINE: To make an online payment, click the Payment icon to the right.
       (NOTE:  You must have a valid email address to use the online option)
    -  PHONE: To make a credit or debit card payment over the phone, contact our Billing Services department at (800) 238-9398.

Check/Money Order
Please mail checks or money orders to:

Sample Fire District
P.O. Box 3510
Silverdale, WA 98383

Other Payment Arrangements
Please contact our Billing Service department at (800) 238-9398 if you wish to make other payment arrangements.

payment
 

How to Contact Us


For more information or to make payment arrangements, please contact our billing department at the phone number, fax number or email address provided below:

1) Call our billing service department at (800) 238-9398. Please refer to the account number located on the top section of your statement.

2) Email a response to our request for insurance information form or any questions you may have to the following email address: Sample@emspatient.com

3) Fax documents to the Sample Fire District billing service department:
      Fax # (360) 394-7094.