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- Billing Information
During your transport to the hospital by ambulance, you were most likely asked by the ambulance attendant to provide your health insurance information and possibly auto insurance. This information along with your signature on a form allowing us to bill your insurance company is necessary for us to expedite payment for services. The following information will help you understand the billing process, what you can expect from us and what we need from you.
In order for us to bill your insurance company, we must have your authorization in the form of a signature. We make every attempt to get this signature at the time of service; however, that is not always possible. If we do not have your signature, you can download and print the Signature Authorization Form (PDF). Complete all information on the form and mail it (P.O. Box 407 Dumont, Colorado 80436) or fax it (303-567-4710) immediately.
We will electronically submit all ambulance service claims for Medicare Part B patients. Once Clear Creek Emergency Medical Services (EMS) has received payment from Medicare and we have written off the agreed amount with Medicare, we will submit a claim to the patient's secondary insurance provider.
Clear Creek EMS/Ambulance is not a contracted provider with any insurance company. We will, however, submit a standardized claim to your insurance company. How much of your claim is paid by your insurance company will depend on your policy, deductibles, and the insurance company's standardized fee structure for services. Please take a moment to read "Explanation of Benefits (EOB)" from your insurance company when you receive it in the mail. It will explain what amount was paid toward the ambulance charges. Any amount remaining after the insurance has paid their portion will be reflected on your next monthly bill. Any amount not paid by your insurance company is your responsibility.
Blue Cross/Blue Shield Insurance
Most insurance companies will mail their payments directly to us to apply to your bill. Blue Cross/Blue Shield does NOT mail their payments to us; rather they will send the check to you the PATIENT. Please endorse the check and mail it to us or deposit this check and write a check to us for the total amount due.
Payment for Services
If you do not have insurance coverage for ambulance transportation, or you owe a balance after your insurance has paid, payment is your responsibility. Please call our office at (303) 679-4215 to set up a workable monthly payment plan. We accept cash, check, and Visa, MasterCard, and Discover cards. If you wish to pay via credit card, please call or fax us your credit card information.