Welcome
Dear
Patient,
Thank you
for visiting
our
Emergency
Medical
Services web
site. We are
a
third-party
billing
service
contracted
by the
Seattle Fire
Department
to handle
billing
related to
EMS
transports
provided by
the fire
department. 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.
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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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Informacon del
seguro
Por favor,
revise su
factura/estado
de cuenta para
ver si hay una
sección de
MENSAJE
IMPORTANTE
en la parte
superior. Si no
tenemos
información del
seguro, o si
necesitamos una
firma, se
incluyó una
solicitud con su
estado de cuenta.
Si tenemos
información de
seguro, se ha
facturado a la
compañía de
seguros y el
estado de cuenta
refleja
cualquier saldo
restante que
pueda adeudarse.
Si hay algún
otro seguro que
se pueda
facturar, por
favor
proporciónenos
esa información.
Puede descargar
y completar el
formulario de
información del
seguro a la
derecha y
enviarlo por
correo, fax o
correo
electrónico con
una copia
escaneada al
departamento de
servicios de
facturación.
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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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Asistencia
financiera
La
asistencia
financiera
está
disponible
para
aquellos que
son
elegibles.
Si su
ingreso
anual o el
de su
familia es
igual o
inferior a
las pautas
nacionales
de pobreza
para esta
área, se
puede
descargar
una
solicitud
usando el
enlace a la
derecha.
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Consumer Rights
Notice
In
Washington
State, when you
get emergency
care or are
treated by an
out-of-network
provider at an
in-network
hospital or
ambulatory
surgical center,
you are
protected from
surprise billing
or balance
billing for
amounts beyond
patient
responsibility
under your
medical
insurance plan.
Please see your
Consumer Rights
on Balance
Billing in the
document on the
right.
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How to
Contact Us
We are a
third-party
service
contracted
by the
Seattle Fire
Department
to handle
ambulance
transport
billing.
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
billing
service
department:
Fax #
(360)
394-7094.
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