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.
|
|
|
|
|
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.
|
|
|
|
|
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.
|
 |
|
|
|
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 County FPD #1
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.
|
 |
|
|
|
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.
|
|
