We partner with Cornerstone Adminisystems to aid with our billing and compliance services. To pay a bill for ambulance or non-emergency transport services or to update insurance information with our billing agency, visit this link.
To speak with a representative from our billing company, please dial 717-249-0012 option 1 and listen to the prompt to reach the correct person.
If you wish to pay for an ambulance membership, click here.
Here you can download and view our common forms. If you are scheduling a transport, your insurer may require you (or your patient) to have a Physician’s Certification Statement completed and signed by the appropriate person. Please check with your insurance to see what they require. These forms are for public use, we hope they help you with our service.
Notice Of Privacy Practices An online viewable version of our current HIPAA Notice of Privacy Practices
HIPAA signature form– A downloadable version of our HIPAA signature form.
Physicians Certification Statement– A downloadable version of our PCS form, required for all BLS and ALS non-emergency medical transports
Authorization for PHI Use/Disclosure– The form to authorize a disclosure to a third party of your protected health information.
Request for PHI Accounting– The form to authorize an accounting of disclosures of your protected health information.
Request for PHI Confidential Communications– The form to request confidential communications of your protected health information.
Patient Request for PHI Restriction– The form to request protected health information be restricted.
Note- All authorizations and requests are subject to approval by the HIPAA Privacy and Compliance officer. Please note, if you are a power of attorney for a patient requesting records, you will need to provide a copy of the power of attorney form in order to obtain records. Patients may be asked to provide ID proving their identity. Please contact HIPAA Officer Nathan Harig with any questions using this request form.
If you are looking for an application for our annual ambulance subscription drive, please note that you can now purchase and renew subscriptions online.
For employment and volunteer opportunities, click here.
Cumberland Goodwill Fire Rescue EMS
To provide feedback about our service, visit this link
Billing Office Phone Number (For incidents after 1/1/10)- 717-249-0012 option 1
Billing Office Phone Number (For incidents prior to 1/1/10) – 1-800-367-0512
Email us using the form on this site. Please do not put any protected health information into this form in order to protect your identity and HIPAA privacy rights. If you need to contact us regarding a patient trip, please use one of the phone numbers above, or simply request us to contact you via a secure system in the message body.
Our current ambulance service base rates are below. Please note that this does not reflect the cost after memberships or payments from medicare, medicaid, or insurance contractual allowances. Actual charges will vary greatly.
Cumberland Goodwill does not participate in-network with any insurance provider due to low reimbursement rates.
Non-emergency services may be subject to additional charges and may be governed by the Public Utilities Commission. Questions about specific quotes or service availability can be directed to our office by dialing 717-249-0012 option 1.
|Advanced Life Support Level 1||$1911.25|
|Advanced Life Support Level 2||$2061.56|
|Basic Life Support Emergency||$994.94|
|Per Mile Charge- Ambulance||$16.88|