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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.
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Insurance Information
If we do not have insurance information, 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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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/eCheck
A convenience fee will apply when making payments by credit card or eCheck. For credit cards, the fee is 2.95% of the invoice amount (Minimum Transaction Amount: $2.00). For eChecks, the fee is $3.00.
(NOTE: You will be asked for information appearing on your invoice/statement, so it should be readily available. Verify that
Lewis County Fire District No 5
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.
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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.
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