Financial Assistance


logo

Exceptional Care. Passionate People.

 

 

Area Ambulance Service is a not-for-profit organization that provides both emergency and non-emergency transportation. As part of our commitment to provide charitable services to patients in our community, a Financial Assistance Program has been developed.

 

The Program:

  • Provides discounts on transportation charges for patients based upon the patient’s income and the size of their family.
  • Based upon a patient’s need, may discount 10% to 100% of that patient’s bill.

If you are under 21 years of age and a full time student, this application needs to be completed by your family.

To qualify for this program, patients submit an application to Area Ambulance Service. Please download, print and fax, mail or drop off our Financial Assistance Program Application. Please contact our billing Department with questions regarding eligibility.

 

 

The Following Documentation Should be Included With Your Application:

 

  • Bank statements for the past 2 months
  • Pay stubs for the last 3 pay periods
  • W-2 forms for the most recent tax year
  • Federal tax forms for the most recent year if filed
  • Self-employed applicants should submit tax forms for the past 3 yrs
  • Pension benefits
  • Unemployment benefits
  • Social Security or Social Security Disability benefits
  • Please provide a letter if none of the above apply indicating how you support yourself if you have special circumstances and/or cannot complete the application in its entirety

 

 

Please return your completed application along with the required documentation. For assistance with your questions, please contact our Customer Service Department at 1-800-291-2606.

 

 

Area Ambulance Service
2730 12th Street SW
P.O. Box 362
Cedar Rapids, IA 52404
Phone: (800) 291-2606
Fax (309) 494-6537

 

 

Financial Assistance Application:    Financial Assistance