Ambulance Transport Billing Services
The Lynchburg Fire Department utilizes Emergency Medical Services (EMS) Management and Consultants, Inc., to provide prompt and accurate billing and filing of insurance claims for citizens who use the Lynchburg Fire Department Ambulance Service.
EMS Management and Consultants, Inc. utilizes the most up-to-date computer system for patient billing and is available to assist citizens with a broad range of ambulance billing issues.
Our goal is to provide excellent customer service by working closely with patients, insurance companies, hospitals, and doctors during the billing process.
Obtain additional information:
Notice of Privacy Practices
Our Notice of Privacy Practices provides information about how we may use and disclose protected health information about you. A copy of Notice of Privacy Practices is located on the City of Lynchburg, Fire Department website. We will provide you with a copy of this notice upon your request. As provided in our notice, the terms of our notice may change. If we change our notice, you may obtain a revised copy. You have the right to request that we restrict how protected health information about you is used or disclosed for treatment, payment or health care operations. We are not required to agree to this restriction, but if we do, we are bound by our agreement. By signing this form, you consent to our use and disclosure of protected health information about you for treatment, payment or health care operations. You have the right to revoke this consent, in writing, except where we have already made disclosures in reliance on your prior consent. I have been given the right to review and receive a copy of Notice of Privacy Practices.
I request that payment of authorized Medicare, Medicaid, or any other insurance benefits be made on my behalf to the City of Lynchburg for any services provided to me by the Lynchburg Fire Department (LFD) now or in the future. I understand that I am financially responsible for the services provided to me by LFD. Regardless of my insurance coverage, and in some cases, I may be responsible for an amount in addition to that which was paid by my insurance. I agree to immediately remit to the City of Lynchburg any payments that I receive directly from insurance or any source whatsoever for the services provided to me and I assign all rights to such payments to the City of Lynchburg. I authorize the City of Lynchburg to appeal payment denials or other adverse decisions on my behalf without further authorization. I authorize and direct any holder of medical information or documentation about me to release such information to the City of Lynchburg and its billing agents, and/or the Centers for Medicare and Medicaid Services and its carriers and agents, and/or any other payers or insurers as may be necessary to determine these or other benefits payable for any services provided by LFD, now or in the future. A copy of this form is as valid as an original.