Stretcher Transport - Amerikare Ambulance

3877 E Livingston Ave, Cbus oh 614-626-0466

Latest Updates

Get the latest traffic updates in Columbus.

When we think of ambulances, we think of emergencies and life-threatening situations. But did you know that there are some cases in which you can schedule ambulance services in advance for non-medical issues and even special events. This is something that many future patients don’t know about because they aren’t certain about what services their insurance will cover. If you know that you need help getting to the hospital for issues related to your health, know that it doesn’t have to be in an emergency setting. Please give us a call to discuss your transportation options 614-626-0466.

Get the latest traffic updates in Columbus.

Menu Close

Coverage Information Guide for Carriers that Amerikare Accepts

Please call for wheelchair rates

Insurance Carrier	Ambulance Non-Emergent	Discharge
AARP
Aetna
Aetna Medicare Advantage
Aetna Mycare/ Logisticare
Anthem BCBS	Limited
Caresource
Cigna	Limited
Medicaid
Medical Mutual of Ohio	Limited
Medicare	Limited	Limited
Molina
Molina Mycare
Paramount Advantage

* Required Fields - Please complete all required fields before submitting form & enter N/A if there is nothing to add in a field

Patient's Name*

Date of Birth*

Gender*

Weight*

Primary Insurance*

Insurance Number*

Secondary Insurance*

Insurance Number*

Social Security Number*

Medicare A/100 Day Stay*

YesNo

Please provide face sheet for patient

Private Pay Contact Information*

Transport Date*:

Appointment Time*

Reason for Transport*:

Special Needs*

Any patient needing vent could be charged additional fees if using AmeriKare equipment

Pick Up Location*

Room #*

Address*

City*

State*

Zip*

Pick up location additional notes*

Drop Off Location*

Room #*

Address*

City*

State*

Zip*

Drop Off location additional notes*

Dr's Name*

Phone Number*

Requestor Name*

Requestor Phone Number*

Requestor’s Email*

(*Please note if this transport is a wait and return additional charges may apply* the first 30 minutes are included in the facility rate)
****Over this will be charged $60.00 per 15 minutes increments****

Please fill the entire document(s) below and fax them to AmeriKare at 614-626-0910 prior to the requested transportation date to avoid delays with transportation.

Facility Payment Agreement

Administrator/Authorized personnel: (Type name)*

Administrator/Authorized personnel*(Sign with your mouse, touchpad or touch screen to sign)

Download Certification Of Necessity Download Physician Certification

Non Emergent

Stretcher Transport Request

Coverage Information Guide for Carriers that Amerikare Accepts

Please call for wheelchair rates

Please provide face sheet for patient

Facility Payment Agreement