Billing & Records Request Information
At Montgomery County EMS, we are happy to provide ambulance transport for all your medical emergencies to Tennova Medical Center, Blanchfield Army hospital, or Tennova Sango.
Our billing staff in the business office is available to you Monday through Friday from 7:30 a.m. to 4:00 p.m. CST with the exception of Federal holidays. Our billing staff is ready to assist you with any concerns you may have related to insurance matters and/or information on your account with the Montgomery County EMS.
Payments can be made in person or by mail any time from 7:30 a.m. to 4 p.m. CST. Our office accepts cash, personal checks and money orders. Credit card payments are also accepted by phone and or online. We accept Visa, and Mastercard only. Please know that when using a card to pay you will be subject to a 2.5% fee.
We are happy to file insurance on behalf of the patient and currently accept most forms of insurance to include TennCare, Medicare, TriCare and commercial carriers. However, we do not file claims for out-of-state Medicaid programs with the exception of Kentucky. We do not file claims for insurance companies based in other countries. We do file claims with automobile insurance carriers; however, the patient is responsible for payment of the invoice if the carrier has not paid the claim within 90 days of the filing date. We are NOT contracted with private insurance companies.
Accounts are held for 90 days from the date of the patient’s transport. We keep the patient informed of the account’s status by mailing out, invoices, statements and final notices. If an account has not been paid or a payment agreement has not been reached at the end of the 90-day period, the account will be held in a collection status and turned over to Credit Bureau Systems, Inc. Please keep our office informed of any address changes or if you have not received correspondence from us.
“Accounts may be forwarded to collection earlier than 90 days if our correspondence has been returned by the United States Postal Service.”
Records Request Information
If you are the patient
- Please bring a valid photo ID such as a driver's license to the business office at 601 Dunlop Lane. You will also need to fill out and sign a release form provided to you.
- If the patient is a minor the parent will need to bring a valid photo ID and the child's birth certificate to the business office at 601 Dunlop Lane. You will need to fill out and sign a release form provided to you. If you are the legal guardian, you will need to bring legal documents showing proof of guardianship.
- If the patient is deceased, the legal next of kin will have to show proof of relationship along with the patient's death certificate.
- Please remember that due to HIPPA Laws we are NOT ALLOWED to give any medical records without proper authority.
If you are a Law Firm
- Please fax or mail a signed HIPPA medical release form on behalf of your client to Montgomery Co. EMS. Fax number and mailing address is found below.
- There will be a $20.00 fee associated with the request for documentation.
To print a copy of a medical release form, click here
Questions? Concerns?
- For billing questions, please call (931) 648-5737.
- We are located at 601 Dunlop Lane, Clarksville, TN 37040
- Fax number (931) 645-5702
- If your account has been transferred to collection status, please contact Credit Bureau Systems at (931) 647-5614 for further assistance.
- Privacy Practices
Thank you for using the services of Montgomery County EMS.