The EMS Records Unit is responsible for responding to requests for records concerning ambulance transport services provided to patients. To review the Notice of Privacy Practices, please click here.
UNDERSTANDING AN AMBULANCE BILL
City policy establishes full cost recovery associated with providing ambulance transportation to patients. The charges for ambulance transportation are established by City ordinance and the current rates are set forth in Los Angeles Administrative Code Section 22.210.2(b). Even if a patient has insurance, their insurance may not cover the cost of the ambulance transport or may pay only a portion of the bill. This applies to Medicare, Medi-Cal, and private insurers. The LAFD’s billing contractor, Intermedix, will make every attempt to obtain payment from a patient's insurance carrier(s) but, if they are unable to verify insurance coverage or a carrier either denies a claim or pays only a portion of the bill, then the patient is responsible for any unpaid charges resulting from the ambulance transport.
Ambulance Billing Questions
Information regarding an ambulance bill may be obtained online from the LAFD EMS billing contractor, Intermedix, at www.intermedix.com/billpay. From this website a patient or authorized representative may
- obtain the balance on the account
- update the patient's insurance information
- make a payment using a credit/debit card
Intermedix representatives are available by phone by calling (888) 772-3203 between 7:00 a.m. and 5:00 p.m. PST.
To protect patient privacy, representatives must speak with the patient or a minor patient's parent or legal guardian. Unless authorized by a patient to receive medical information and records, third-party callers may only update a patient's insurance information.
Errors or Omissions
The LAFD ambulance billing contractor, Intermedix, can assist with correcting any errors or omissions on an ambulance bill. They may be reached at (888) 772-3203. To protect the patient's privacy, representatives must speak with the patient or a minor patient's parent or legal guardian. Third-party callers may only update a patient's insurance information. A patient may be asked to submit a completed Request For EMS Billing Correction or Exemption form along with an explanation of the billing error and any supporting documentation.
For Those Experiencing Financial Difficulties
Patients experiencing financial difficulties may qualify for low-income assistance. Eligibility criteria are explained on the Request For EMS Billing Low Income Assistance form. Patients requesting low-income assistance should submit the completed form and all required supporting documentation proving eligibility to the LAFD at the address listed on Page 2 of the form.
PATIENT MEDICAL RECORDS
When patients are treated and/or transported via ambulance by LAFD emergency medical services personnel, records are routinely prepared and may be available to the patient and his or her authorized representatives. Fees may apply. Since medical records are highly confidential under Federal and State law, the LAFD must follow stringent guidelines when responding to requests to release medical records and other protected health information (PHI). These requirements are designed to ensure that a patient’s medical record remains confidential and is only released at the request of the patient or as otherwise allowed under law.
A patient or authorized representative may request copies of medical records by following the instructions listed below:
1. Complete an Authorization For Release of Protected Health Information form;
The purpose of this form is to provide the LAFD with sufficient documentation to verify that the patient is authorizing the release of their confidential PHI or that a third-party representative, such as a family member, care giver, attorney, etc., is authorized to act on the patient’s behalf with regards to the release of confidential PHI. To avoid delays in processing, all required information and supporting documentation, including any applicable fees, must be provided.
If a patient is incapacitated or otherwise unable to sign an authorization form and an authorized representative is acting on their behalf, the representative’s relationship to the patient must be identified in Section F and official documentation evidencing the representative’s legal authority to act and sign on the patient’s behalf must be provided. The following legal documents are commonly submitted:
- Marriage Certificate
- Death Certificate
- Birth Certificate (of minor patient)
- Medical Power of Attorney or Advance Health Care Directive
2. Include a good-quality photocopy of the signatory’s valid (unexpired) government-issued photo ID that clearly shows the signature;
The signature on the patient’s or authorized representative’s photo ID must match the signature as it appears in Section G on the “Authorization For Release of Protected Health Information” form. Any discrepancy will result in the request being denied or postponed pending receipt of a new form with a valid, matching signature.
If a patient does not have a valid government-issued photo ID, the “Authorization For Release of Protected Health Information” form may be notarized, as indicated in Section H of the form.
3. Include any required fees. There is no charge to patients requesting records for themselves. For all other requests the following fees apply:
|FOR EACH RECORD||FEE*|
|Itemized Statement Only||No Charge|
|Patient Care Reports & Itemized Statement||$13|
|9-1-1 Audio Recording||$10|
*Make checks or money orders payable to LA CITY FIRE.
4. Submit the completed authorization form, all supporting documentation, and applicable fees to LAFD EMS Records via:
- Mail to the address listed on the bottom of Page 3 of the authorization form, or
- Fax to (213) 978-3813, or
- E-Mail to LAFD.EMSRecords@lacity.org
Questions regarding the release of medical records should be directed to LAFD EMS Records via e-mail at LAFD.EMSRecords@lacity.org or via phone at (213) 978-3648.
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