Billing and Medical Records

Our care doesn't stop when the ambulance leaves you!

If your ambulance transport meets the coverage requirements imposed by your insurance carrier, Liberty Ambulance Service will submit your claim for you. If not, we will assess your situation to determine who is the appropriate party responsible for payment of your transport. If you are responsible for payment, one of our Billing Representatives will be happy to work with you to make the process as easy as possible. Please contact our billing department with any questions or concerns, and make sure to have your insurance cards on hand when you call if you believe any information we have may be incorrect.

To pay your bill by credit card you may call us at 904-805-0293.

Out of Town Transports

If the origin of your transport is not located in Jacksonville or one of the following counties, then we must have permission to go into that county. Please be mindful that this special permission is needed when you are requesting a transport originating from an unlisted county.

• Baker
• Union
• Suwannee
• Clay
• Duval
• Nassau
• Flagler
• Volusia

**Out of town transports are usually considered not necessary by insurance.

Forms:

Assignment of Benefits Signature Form

Certificate of Medical Necessity form for Healthcare Providers 

Hardship Request Form

Medical Records Release Request

Non-Emergency Transportation Request Form (Facilities Only)

Need copies of your medical records?

One of our Billing Representatives will be more than happy to guide you through this process! Call 904-805-0293 to discuss your needs.