Follow this simple 4 step process to receive reimbursement for driving to approved non-emergency medical appointments:
Call Mid-Coast Connector toll-free at (855) 930-7900 with your appointment information no later than two full business days prior to your appointment. You must call with your appointment information prior to going to your appointment in order to receive reimbursement.
Take the trip, bringing the reimbursement form.
Have your medical provider verify that you attended the appointment by signing the reimbursement form in blue ink only. Make sure they use the box located in the upper right-hand corner of the reimbursement form. You can download the reimbursement form by clicking here..
Complete the reimbursement form. Be sure to follow these instructions for the person with the appointment. Fill in:
- First and last name.
- Date of birth.
- MaineCare number.
- Address, including the town.
- Date and time of the appointment.
- Trip beginning and odometer readings.
- Name, address, and telephone number of the medical provider and attending physician.
- Name and address of the person to be reimbursed (If different than yourself).
- Attach receipts for tolls, ferries, etc. and fill in the blanks (For prior authorized out of state travel only)
Sign the reimbursement form and drop off or mail with receipts to:
9 Field StreetSuite 201
Belfast, ME 04915
If you need more reimbursement forms you can download them by following this link. Or simply give us a call, and we will gladly mail you more forms.
For more instruction, or if you have questions, please call us any time toll free at (855) 930-7900. We always enjoy hearing from you.