AMBULANCE BILLINGBeginning 1/1/2013, the City of Madison utilizes billing services from Intermedix. For more information, please visit:
Ambulance Hardship Waiver InformationThe City of Madison Hardship Waiver (PDF) is designed to help people who have no insurance or the means to pay. Failure to completely and accurately provide the information required below may result in denial of the waiver.
The schedule below provides the percent of fee waived based on total family income and number of individuals in household.
HARDSHIP WAIVER REQUIREMENTSIf you would like to be considered for a waiver, ALL FOUR of the following steps must be completed and submitted to our office:
STEP 1: SIGNED STATEMENT
STEP 2: PROOF OF TOTAL FAMILY ANNUAL INCOME = A SIGNED COPY OF YOUR MOST RECENT FEDERAL INCOME TAX FORM, including social security (line 20a).
STEP 3: ARE YOU RECEIVING OR ELIGIBLE FOR GOVERNMENTAL ASSISTANCE
STEP 4: DO YOU HAVE PRIVATE HEALTH OR ACCIDENT INSURANCE?