Patient Billing Services

Care Ambulance Service, Inc. is dedicated to providing exceptional service to our customers. We believe it is very important to extend the skill and passion that was received from your field personnel on through to the Billing Process. Our business office will assist you in processing the necessary paperwork to ensure prompt payment from your insurance carrier.

The tabs below provide you quick access to a library of downloadable and printable forms, detailed answers and explanations to billing questions, current County approved Ambulance Rate Schedules, and access to pay your bill online, or submit needed information.

It is very important to respond to any statement we may send you, as most of the time it includes a request for missing information.

Thank you for using Care Ambulance Service.

Billing Library and Reference Area

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Your 911 emergency ambulance transportation coverage varies depending on the individual insurance policy that you have. In general, almost all insurance plans cover some portion of 911 emergency ambulance services, but it is important to review your insurance coverage to understand the exact limitations and requirements of your individual policy. If you are not sure, call your insurance carrier to obtain a coverage guide.

If your policy does not provide 100 percent coverage for 911 emergency ambulance transportation, you may be required to pay a deductible or co-payment as outlined in the insurance policy. Payment of all deductibles and co-payments are due upon reciept of the bill.

It is important that you respond to our request for insurance information so we may file your claim in a timely manner and reduce the need for you to pay up front. We are not obligated to wait for your insurance to pay but we do so as a courtesy to you.

In addition to 911 emergency ambulance services, Care Ambulance provides comprehensive non-emergency ambulance services to patients who need to be safely transported from one facility to another. These services may be at the Basic BLS level, at the Paramedic ALS level, or at the Critical Care level depending on the medical need.

While most insurance plans may cover non-emergency transports, they all restrict non-emergency services to those situations that meet specific medical necessity standards and are ordered by a physican. Each insurance carrier will determine whether or not the ambulance transportation meets their medical necessity criteria. It is important to check with your insurance provider to determine the specific requirements for payment related to non-emergency transportation.

If you are unsure if a non-emergency ambulance tranport will be covered, discuss this with your Case Manager, Discahrge Planner, Doctor, or Nurse and have them obtain prior authorization from your insurance provider prior to ordering the ambulance.

Medicare and Medicare Advantage Plans will cover 911 emergency ambulance transportation to the nearest appropriate medical facility if the transport is a result of a sudden onset of a medical condition that could reasonably be expected to result in placing the patient's health in serious jeopardy. If you feel you are having an emergency and call 911, Medicare will cover the transport.

If we were unable to get your signature when you were transported to the hospital, you will receive a request in the mail asking for you to confirm your Medicare information and authorize us to bill Medicare for you. This request may look like a bill, however, all we need is your insurance information. If you recieve a bill from us and have a question, please call your account representative as soon as possible.

Medicare will pay 80% of the Medicare Allowable ambulance rates for your area. If you have a secondary insurance, we will bill that for you as well. If not, you will be responsible for the 20% remaining as a copay. You can find your area Medicare Allowable Rates here.

If you need financial assistance due to cover your copay obligation, you may benefit from our Senior Care 911 Emergency Ambulance Membership Program. It is for Seniors on Medicare. You can find more information on the Membership Program by clicking on the Senior Care tab below.

Senior Care Membership Plan Medicare Fee Schedule
Pay Your Bill

While non-emergency inter-facility ambulance transportation is a Medicare benefit, Medicare will not pay for non-emergency ambulance service unless the patient meets medical necessity standards. At minimum the patient must be unable to get out of bed without assistance and unable to walk, unable to sit in a chair or wheelchair, and/or that transportation by any other means would pose a danger to the patient's health. You can review these standards below.

Medicare also will not pay for ambulance transportation to a preferred hospital or facility that is not the nearest appropriate facility, or for the convenience of the patient, the family or physician. Medicare does not pay for wheelchair, stretcher or gurney transportation. Medicare does not typically pay for discharges home to a personal residence.

For both emergency and non-emergency transportation service, Medicare will pay 80 percent of their allowable rate. The remaining 20 percent will be due from you or the your secondary insurance carrier.

If Medicare denies your claim due to not meeting the medical necessity standards, you will become responsbible for the entire amount.

If you are unsure if a non-emergency ambulance tranport will be covered, discuss this with your Case Manager, Discahrge Planner, Doctor, or Nurse and have them obtain prior authorization from your insurance provider prior to ordering the ambulance. In determining medical necessity the patients doctor must certify the findings on a PCS or Physicians Certification Statement. Click here to view a PCS form and the requirements.

If you find that you do not meet the medical necessity standards Medicare mandates, you can order a Concierge Transort instead. To learn more about our Concierge Service click the link below.

Medical Necessity Form Concierge Service Information
Pay Your Bill

Medi-Cal is a federal program adminstered by the state that provides basic medical insurance to people who qualify for the program. The coverage of 911 and non-emergency ambulance services is a covered benefit under the program. While 911 emergency ambulance service is generally covered, non-emergency ambulance service must meet strict medical necessity requirements much like Medicare.

Medi-Cal also offers wheelchair and stretcher services in addition to ambulance service.

All non-emrgency transportation options do require prior authorization from Medi-Cal. In addition, there is no copay of deductible for Medi-Cal recieptients. Medi-Cal pays 100% of the established Medi-cal ambulance, wheelchair, or stretcher rate. Click the link to see the medical necessity form for non-emergency ambulance services.

Medical Necessity Form

If a you do not have health insurance coverage, the bill for Care Ambulance services will be due directly from you. Payment is due within thirty (30) days of receipt of the invoice. Care Ambulance accepts personal checks, Visa, American Express and MasterCard. Payment can also be made by phone &/ our website.

If you meet Medi-Cal eligibility requirements, you may be able to enroll in a Medi-cal program and have the coverage retroactively cover your claim. Most hospitals will assist you in signing up if you qualify. As a last resort, we can set up a payment plan for you.

The 911 emergency ambulance rates are set and approved by the County Board of Supervisors for both Orange and Los Angeles Counties. A 911 emergency ambulance transport bill will typically include a base charge for the transport, a mileage fee and charges for other procedures, supplies or medications administered.

The base charge can be either a BLS or ALS rate depending on the level of care needed. BLS or Basic Life Support is when you are treated and transported to the hospital with a non-life threatening injury. ALS or Advance Life Support is when you are treated and transported to the hospital and a Fire Department Paramedic continues to treat you in the ambulance.

If you had an I.V. or were transported to the hospital on the heart monitor, that would be ALS. The ALS base charge is generally about $300 more than the BLS base charge. When those fees are collected, the ALS portion of the fee is passed back to your Fire Department to pay for the Paramedic. Care Ambulance does not keep the ALS fees.

Los Angeles County also sets ambulance rates for non-emergency services and Care Ambulance indexes this rate in the other counties we serve. Our current Ambulance Rete Schedule is posted in the lobby of our Corporate Headquarters and can be viewed here as well.

2018 Ambulance Rate Schedule
Pay Your Bill

Obtaining the patients signature or the signature of a parent of a minor, is necessary to both properly identify the patient and/or communicate and share information with the person making the medical decisons on the patients behalf. This signature enables Care Ambulance to bill the insurance carrier on the patient’s behalf and allows the medical insurance carrier to pay Care Ambulance directly.

Signature Request Form
When we bill your insurance you should receive an EOB or Explanation of Benefit from your insurance carrier. Thie EOB will explan to you what your insurance company paid and indicate what is your responsibility. Depending on your coverage, your ambulance transport may be considered to be a non-covered service, out-of-network, or applied to your annual deductible. You should contact your insurance company and then please contact your Care Ambulance account representive to discuss further.
Care Ambulance Service is the billing agency for The City of Anaheim Fire Department. If you are not a member of their Paramedic Subscription Program, you will receive a bill from Care Ambulance Service for the actual transport and a separate bill from the City of Anaheim for the city's response to the 911 call. This is a city user fee and not part of the ambulance service you received. Please contact www.anaheim.net for more paramedic subscription program information.
Care Ambulance Service is the billing agency for The City of Fullerton Fire Department. If you are not a member of their Paramedic Subscription Program, you will receive a bill from Care Ambulance Service for the actual transport and a separate bill from the City of Fullerton for the city's response to the 911 call. This is a city user fee and is not part of the ambulance transport. Please contact (714) 738-6341 for more paramedic subscription program information.
Care Ambulance Service is the billing agency for The City of Buena Park Fire Department. If you are not a member of their Paramedic Subscription Program, you will receive a bill from Care Ambulance Service for the actual transport and a bill from the City of Buena Park for the response to the 911 call. Please contact (714) 562-3717 for more paramedic subscription program information.

The links below will take you to a downloadable form in PDF format. Using these forms to submit information will save you time in filing your insurance claims, obtaining medical necessity determinations, and other important forms and information.

Medical Necessity Form Motor Vehicle Accident Form Signature Request Form Permission for the Release of Personal Healthcare Information Concierge Service Information
Pay Your Bill

Amblance Rates are generally set by a government entity. The Federal Government sets the rates for Medicare, the State of California sets the rates for Medi-Cal, and the County Board of Supervisors sets the 911 ambulance rates for the their County.

Medicare Fee Schedule 2018 Ambulance Rate Schedule

Purpose of This Notice: This Notice describes your legal rights, advises you of our privacy practices, and lets you know how Care Ambulance Service, Inc. is permitted to use and disclose Personal Health Information (PHI) about you.

Uses and Disclosures of Your PHI We Can Make Without Your Authorization

Care Ambulance Service, Inc. may use or disclose your PHI without your authorization, or without providing you with an opportunity to object, for the following purposes:

Treatment. This includes such things as verbal and written information that we obtain about you and use pertaining to your medical condition and treatment provided to you by us and other medical personnel (including doctors and nurses who give orders to allow us to provide treatment to you). It also includes information we give to other healthcare personnel to whom we transfer your care and treatment, and includes transfer of PHI via radio or telephone to the hospital or dispatch center as well as providing the hospital with a copy of the written record we create in the course of providing you with treatment and transport.

Payment. This includes any activities we must undertake in order to get reimbursed for the services that we provide to you, including such things as organizing your PHI, submitting bills to insurance companies (either directly or through a third party billing company), managing billed claims for services rendered, performing medical necessity determinations and reviews, performing utilization reviews, and collecting outstanding accounts.

Healthcare Operations. This includes quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, creating reports that do not individually identify you for data collection purposes, fundraising, and certain marketing activities.

Fundraising. We may contact you when we are in the process of raising funds for Care Ambulance Service, Inc., or to provide you with information about our annual subscription program.

In addition, we may use your PHI for certain fundraising activities. For example, we may use PHI that we collect about you, such as your name, home address, phone number or other information, in order to contact you to raise funds for our agency. We may also share this information with another organization that may contact you to raise money on our behalf. If Care Ambulance Service, Inc. does use your PHI to conduct fundraising activities, you have the right to opt out of receiving such fundraising communications from Care Ambulance Service, Inc.. If you do not want to be contacted for our fundraising efforts, you should contact our HIPAA Compliance Officer, Mitch Felde, in writing, by phone, or by email. Contact information for our HIPAA Compliance Officer is listed at the end of this Notice. We will also remind you of this right to opt out of receiving future fundraising communications every time that we use your PHI to conduct fundraising and contact you to raise funds. Care Ambulance Service, Inc. will not condition the provision of medical care on your willingness, or non-willingness, to receive fundraising communications.

Reminders for Scheduled Transports and Information on Other Services. We may also contact you to provide you with a reminder of any scheduled appointments for non-emergency ambulance and medical transportation, or for other information about alternative services we provide or other health-related benefits and services that may be of interest to you.

Other Uses and Disclosure of Your PHI We Can Make Without Authorization.

Care Ambulance Service, Inc. is also permitted to use or disclose your PHI without your written authorization in situations including:

  • For the treatment activities of another healthcare provider
  • To another healthcare provider or entity for the payment activities of the provider or entity that receives the information (such as your hospital or insurance company)
  • To another healthcare provider (such as the hospital to which you are transported) for the healthcare operations activities of the entity that receives the information as long as the entity receiving the information has or has had a relationship with you and the PHI pertains to that relationship
  • For healthcare fraud and abuse detection or for activities related to compliance with the law
  • To a family member, other relative, or close personal friend or other individual involved in your care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose health information to your family, relatives, or friends if we infer from the circumstances that you would not object. For example, we may assume that you agree to our disclosure of your personal health information to your spouse when your spouse has called the ambulance for you. In situations where you are incapable of objecting (because you are not present or due to your incapacity or medical emergency), we may, in our professional judgment, determine that a disclosure to your family member, relative, or friend is in your best interest. In that situation, we will disclose only health information relevant to that person's involvement in your care. For example, we may inform the person who accompanied you in the ambulance that you have certain symptoms and we may give that person an update on your vital signs and treatment that is being administered by our ambulance crew
  • To a public health authority in certain situations (such as reporting a birth, death or disease, as required by law), as part of a public health investigation, to report child or adult abuse, neglect or domestic violence, to report adverse events such as product defects, or to notify a person about exposure to a possible communicable disease, as required by law
  • For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the healthcare system
  • For judicial and administrative proceedings, as required by a court or administrative order, or in some cases in response to a subpoena or other legal process
  • For law enforcement activities in limited situations, such as when there is a warrant for the request, or when the information is needed to locate a suspect or stop a crime
  • For military, national defense and security and other special government functions
  • To avert a serious threat to the health and safety of a person or the public at large
  • For workers’ compensation purposes, and in compliance with workers’ compensation laws
  • To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or carrying on their duties as authorized by law
  • If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ donation and transplantation
  • For research projects, but this will be subject to strict oversight and approvals and health information will be released only when there is a minimal risk to your privacy and adequate safeguards are in place in accordance with the law.

Uses and Disclosures of Your PHI That Require Your Written Consent

Any other use or disclosure of PHI, other than those listed above, will only be made with your written authorization (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it). Specifically, we must obtain your written authorization before using or disclosing your: (a) psychotherapy notes, other than for the purpose of carrying out our own treatment, payment or health care operations purposes, (b) PHI for marketing when we receive payment to make a marketing communication; or (c) PHI when engaging in a sale of your PHI. You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed medical information in reliance on that authorization.

Your Rights Regarding Your PHI

As a patient, you have a number of rights with respect to your PHI, including:

Right to access, copy or inspect your PHI. You have the right to inspect and copy most of the medical information that we collect and maintain about you. Requests for access to your PHI should be made in writing to our HIPAA Compliance Officer. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials. We have available forms to request access to your PHI, and we will provide a written response if we deny you access and let you know your appeal rights. If you wish to inspect and copy your medical information, you should contact Mitch Felde, our HIPAA Compliance Officer.

We will normally provide you with access to this information within 30 days of your written request. If we maintain your medical information in electronic format, then you have a right to obtain a copy of that information in an electronic format. In addition, if you request that we transmit a copy of your PHI directly to another person, we will do so provided your request is in writing, signed by you (or your representative), and you clearly identify the designated person and where to send the copy of your PHI.

We may also charge you a reasonable cost-based fee for providing you access to your PHI, subject to the limits of applicable state law.

Right to request an amendment of your PHI. You have the right to ask us to amend protected health information that we maintain about you. Requests for amendments to your PHI should be made in writing and you should contact Mitch Felde, our HIPAA Compliance Officer if you wish to make a request for amendment and fill out an amendment request form.

When required by law to do so, we will amend your information within 60 days of your request and will notify you when we have amended the information. We are permitted by law to deny your request to amend your medical information in certain circumstances, such as when we believe that the information you have asked us to amend is correct.

Right to request an accounting of uses and disclosures of your PHI. You may request an accounting from us of disclosures of your medical information. If you wish to request an accounting of disclosures of your PHI that are subject to the accounting requirement, you should contact Mitch Felde, our HIPAA Compliance Officer and make a request in writing.

You have the right to receive an accounting of certain disclosures of your PHI made within six (6) years immediately preceding your request. But, we are not required to provide you with an accounting of disclosures of your PHI: (a) for purposes of treatment, payment, or healthcare operations; (b) for disclosures that you expressly authorized; (c) disclosures made to you, your family or friends, or (d) for disclosures made for law enforcement or certain other governmental purposes.

Right to request restrictions on uses and disclosures of your PHI. You have the right to request that we restrict how we use and disclose your medical information for treatment, payment or healthcare operations purposes, or to restrict the information that is provided to family, friends and other individuals involved in your healthcare. However, we are only required to abide by a requested restriction under limited circumstances, and it is generally our policy that we will not agree to any restrictions unless required by law to do so. If you wish to request a restriction on the use or disclosure of your PHI, you should contact Mitch Felde, our HIPAA Compliance Officer and make a request in writing.

Care Ambulance Service, Inc. is required to abide by a requested restriction when you ask that we not release PHI to your health plan (insurer) about a service for which you (or someone on your behalf) have paid Care Ambulance Service, Inc. in full. We are also required to abide by any restrictions that we agree to. Notwithstanding, if you request a restriction that we agree to, and the information you asked us to restrict is needed to provide you with emergency treatment, then we may disclose the PHI to a healthcare provider to provide you with emergency treatment.

A restriction may be terminated if you agree to or request the termination. Most current restrictions may also be terminated by Care Ambulance Service, Inc. as long we notify you. If so, PHI that is created or received after the restriction is terminated is no longer subject to the restriction. But, PHI that was restricted prior to the notice to you voiding the restriction must continue to be treated as restricted PHI.

Right to notice of a breach of unsecured protected health information. If we discover that there has been a breach of your unsecured PHI, we will notify you about that breach by first-class mail dispatched to the most recent address that we have on file. If you prefer to be notified about breaches by electronic mail, please contact Mitch Felde, our HIPAA Compliance Officer, to make Care Ambulance Service, Inc. aware of this preference and to provide a valid email address to send the electronic notice. You may withdraw your agreement to receive notice by email at any time by contacting Mitch Felde.

Right to request confidential communications. You have the right to request that we send your PHI to an alternate location (e.g., somewhere other than your home address) or in a specific manner (e.g., by email rather than regular mail). However, we will only comply with reasonable requests when required by law to do so. If you wish to request that we communicate PHI to a specific location or in a specific format, you should contact Mitch Felde, our HIPAA Compliance Officer and make a request in writing.

Internet, Email and the Right to Obtain Copy of Paper Notice

If we maintain a web site, we will prominently post a copy of this Notice on our web site and make the Notice available electronically through the web site. If you allow us, we will forward you this Notice by electronic mail instead of on paper and you may always request a paper copy of the Notice.

Revisions to the Notice

Care Ambulance Service, Inc. is required to abide by the terms of the version of this Notice currently in effect. However, Care Ambulance Service, Inc. reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all PHI that we maintain. Any material changes to the Notice will be promptly posted in our facilities and on our web site, if we maintain one. You can get a copy of the latest version of this Notice by contacting Mitch Felde, our HIPAA Compliance Officer.

You have the right to complain to us, or to the Secretary of the United Stats Department of Health and Human Services, if you believe that your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments or complaints, you may direct all inquires to Mitch Felde, our HIPAA Compliance Officer. Individuals will not be retaliated against for filing a complaint. If you have any questions or if you wish to file a complaint or exercise any rights listed in this notice, please contact: (new line) Mitch Felde (New line) Care Ambulance Service, Inc. (New line) 1517 West Braden Court (New Line) Orange, CA 92868 (new line) 714-288-3815 (new line) MitchF@careambulance.net

Care Ambulance/Falck USA complies with applicable Federal civil rights laws and does not discriminate on the basis of age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and gender identity or expression. Care Ambulance/Falck USA does not exclude people or treat them differently because of age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and gender identity or expression. Care Ambulance/Falck USA:

  • Provides free language services to people whose primary language is not English, such as:
  • qualified interpreters or a language line
  • information written in other languages

If you need these services, contact Care Ambulance directly 714-288-3800. If you believe that Care Ambulance/Falck USA has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with:

Director of Compliance Falck USA, Inc. 21540 30th Drive SE, Suite 250 Bothell, WA 98021 Phone: (425) 892-1180 Fax: (425) 892-1189 falckusa@falck.com

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available here, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available here.

Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 714-288-3800

Chinese: 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電714-288-3800.

Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 714-288-3800.

Korean: 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 714-288-3800. 번으로 전화해 주십시오.

French: ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 714-288-3800.

Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 714-288-3800.

Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 714-288-3800.

German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 714-288-3800.

Gujarati: સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 714-288-3800.

Arabic: ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 803-714-288-3800.

Portuguese: ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 714-288-3800.

Japanese: 注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。714-288-3800. まで、お電話にてご連絡ください。

Ukranian: УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 714-288-3800.

Hindi: ध्यान द: यद आप हदी बोलते ह तो आपके िलए मुफ्त म भाषा सहायता सेवाएं उपलब्ध ह। 714-288-3800.

Cambodian: ្របយ័ត៖ េបើសិនអកនិយ ែខរ, េសជំនួយែផក េយមិនគិតឈល គឺចនសំប់បំេរអក។ ចូរ ទូរស័ព 714-288-3800.

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