Charitable Care/Financial Assistance Program
Any individuals wishing to seek a charitable care grant must submit a program application
which is found on our website, at our administrative office, or by contacting our billing
company Medical Business Services, LLC. Supporting financial documentation should be
included with the application that proves the patient is currently receiving or has been
approved to receive financial assistance from a local facility. Proof of financial need will include
an approved financial assistance grant from Central Vermont Medical Center, the University of
Vermont Medical Center, or Copley Hospital. This proof acts as our evidence that a patient is
experiencing financial need in-line with our program requirements.
TO APPLY:
Complete the APPLICATION
& include proof of financial assistance grant from local hospitals
MAIL TO:
Waterbury Ambulance Service, Inc.,
P.O. Box 95
Waterbury Center, VT, 05677
Require the application in a different languge? Contact us at info@waterburyambulance.org
Applications will be reviewed on a rolling basis. Completed applications will be reviewed by the
EMS Chief and may be subject to requiring further supporting documentation. The financial
assistance application determination acts as a direct reflection of the amount of grant
assistance to be authorized by Waterbury Ambulance Service, Inc toward outstanding
ambulance bills.
Notification of approval or denial of a charitable care grant will be done in a timely manner and
will include instruction on how to apply an approved grant amount to their ambulance bills.
All data collected as part of this application process will be safeguarded in all scenarios.
Financial and personal information will be kept confidential in adherence to all privacy laws.
Waterbury Ambulance Service, Inc. does not discriminate any matters based on race, color,
national origin, age, disability, or any other characteristic protected and mandated by law.
This Charitable Care Policy is subject to amendment, modification, or cancellation by Waterbury
Ambulance Service, Inc at any time, with or without prior notice, at its sole discretion. Such
changes may be applied prospectively or retroactively. Furthermore, Waterbury Ambulance
Service, Inc reserves the right to deny any application for charitable care if, in its sole discretion,
the applicant has not fully met all application requirements, provided inaccurate or incomplete
information, or if awarding a grant would not align with the policy's objectives or the service's
financial sustainability. This policy does not create an entitlement to charitable care, and all
decisions regarding eligibility and the extent of any granted waiver are final and binding.
Nothing in this policy should be construed as a waiver of Waterbury Ambulance Service,
Inc right to pursue all available legal remedies for unpaid balances if an application is denied or
not pursued.
Download the full program policy