financial-formsIn an effort to keep orthodontic fees down while maintaining the highest level of professional care, we have established the following financial policy:

A discount will be offered if the patient portion is paid in full prior to the beginning of treatment. An initial payment or down payment will be due before any appliances are placed. The balance will be paid in monthly installments over the treatment time. As a courtesy, we will ask for a payment at your appointment if one is due.

As a convenience to our patients, we accept cash, personal checks, MasterCard, Visa, American Express and Discover. A fee of $25.00 will be charged for any insufficient funds received.

If an account becomes 30 days past due, an automatic service charge of $25.00 will be added each month until the account is brought current. If an account becomes 60 days past due the patient will be put on maintenance only appointments (no teeth movement) until the account is brought current. All accounts will be paid in full prior to having appliances removed.

In cases of serious delinquency, treatment will be discontinued, although we will make every effort to accommodate our patients with temporary financial difficulties.

If a patient has insurance, as a courtesy, we will contact the insurance company to determine if there are orthodontic benefits available. We will do all we can to be of assistance in filing your claim and working with your insurance company to receive the applicable orthodontic benefits.

We do not have access to all of your plan benefits and might not be aware of restrictions and limitations in your policy. Ultimately the patient is responsible for the entire contracted fee regardless of insurance benefits. It is your responsibility to be aware of the benefits and exclusions within your plan. Any amount not covered or paid by your insurance will be the patient’s responsibility.

If there is any change in benefits or coverage, ie; plan termination or a new insurance benefit, it is the patient’s responsibility to contact our office to let us know of the changes.

Sheldon Peck Orthodontics

  • Sheldon Peck Orthodontics - 1792 W 1700 S, Syracuse, UT 84075 Phone: 801-525-1333

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