Non-Emergency Medical Transportation Request for - CT.gov - ct 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information in the designated fields, including your name, address, and contact details. Ensure accuracy as this information is crucial for processing your request.
  3. Next, specify the type of transportation needed. Select from options such as livery service or ambulance based on your medical requirements.
  4. Provide details about your medical appointments, including dates and times. This helps in scheduling the transportation effectively.
  5. Review all entered information for completeness and accuracy before submitting the form. Use our platform's features to save your progress if needed.
  6. Once satisfied, click ‘Submit’ to send your request. You will receive a confirmation notification via email.

Start using our platform today to streamline your Non-Emergency Medical Transportation requests effortlessly!

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Non-Emergency Medical Transportation Rates Types of ChargeWeekday Business HoursWeekends Off Hours Ambulatory Base Rate $25 - $30 $30 - $40 Wheelchair Base Rate $45 - $50 $75 - $90 Stretcher Base Rate $100 - $200 $125 - $225 Additional Mileage Fees $3 - $5 per mile $5 - $7 per mile2 more rows Jul 25, 2022
Please contact MTM at 1-855-478-7350 or click here for assistance with your medical transportation.
Setting Up Your Non-Emergency Medical Transportation (NEMT) Businesses Register your business. Consider partnering with healthcare providers or other organizations. Obtain proper insurance coverage. Invest in reliable vehicles and equipment. Train and hire qualified drivers.
In some cases, Medicare may pay for medically necessary, non-emergency ambulance transportation if you have a written order from your doctor or other health care provider that says the transportation is medically necessary.
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