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  • PLEASE READ THIS BEFORE BEGINNING THIS FORM: 

    It is best to be organized for this form - Collect the Following:

    1. Dental Insurance Information and a Copy of your Insurance Card (if you have one).

    2. Prescriptions - If you have a list already prepared you can attach it to this form. If you don't have a formal list you will be asked for

         a) Name of each Medication

         b) Dose & Frequency

         c) Purpose (Example: High Blood Pressure)

         d) Prescribing Physician (or self)

    3. Supplements, Vitamins, & Over the Counter Medications - If you have a list already prepared you can attach it to this form. If you don't have a formal list you will be asked for

         a) Name of each Item

         b) Dose & Frequency

         c) Purpose

         d) Prescribing Physician (or self)

    3. Physicians - Contact Information including the name, specialty, phone, city, and other information if you have it.  

    4. Photo ID (It is not required but helpful!)

     

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  • Legal Consent: Patients under 18 cannot give consent. Other patients due to mental or other circumstances may not be capable of giving consent. For scheduling surgeries it is important to identify who we need to communicate with to coordinate care. Please call our office if you have any questions.

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  • CONSULTATION AND BIOPSY APPOINTMENT:

    Dr. Alman has over 40 years of experience in the diagnosis and treatment of oral lesions.

    Pre-Appointment:

    • The referring dentist or phyisican often will often send photos and a description as to their observations. Sometimes they call Dr. Alman ahead of the appointment to dicuss the case.
    • Please indicate below any details to help the office ready for your appointment. Include the location, discription, and how long the lesion has been present.
    • We do allow enough time for a consultation and biopsy even if Dr. Alman may decide not to perform the biopsy. This saves the patient to need a second  appointment.

    Consultation and Biopsy Appointment:

         Time: 30 minutes to 1 hour.

         Biopsy Fees:

    • Consultation Only: If a biopsy is not required or performed the consutation fee is $300.
    • Biopsies Fees: From $450-$850. The fee will depend on the location and the complexity of the excision.
    • Dr. Alman is not a Participating Provider for any insurances medical or dental insurance plans. The Fees are paid at the appointment and the staff will assist with insurance filing (except for Medicare) & the member will be reimbursed directly according to the out-of-network benefits and limitations.
    • Pathology Lab & Lab Fees : If a biopsy is performed, it will be sent to Johns Hopkins Oral Pathology Lab. The head pathologist, Dr. Robert Foss, is a long time personal friend of Dr. Alman's. He personally takes care to quickly inform Dr. Alman if any biopsy has a negative diagnosis. The lab does participate with all insurance plans including Medicare. Our office will send the medical insurance information with the lab sample. 

    Follow-up Appointment(s):

    • If biopsy is performed, a follow-up appointment will be made 10 days to 2 weeks later. This appointment is usually scheduled for 15 minutes.
    • At this appointment, Dr. Alman will go over the biopsy report and give a copy to the patient for their records. Future care and follow-up will be discussed.
    • There is no fee for this follow-up appointment.
  • MEDICARE PART B:

    Dr. Alman does not participate with any insurance companies as a prefered provider including with MEDICARE PART B. He has signed a letter with Medicare to Opt-Out of Medicare. This means that patients need to be informed that they will not receive benefits from Medicare and the office is not allowed to file to Medicare.

    Instead, the patient is asked to sign an OPT-OUT LETTER OF AGREEMENT which acknowleges that the office does not participate. 

    We will still need a copy of the medicare card to send to the lab for them to file to Medicare should a biopsy be performed.

  • HMO INFORMATION:

    Dr. Alman does not participate NEED TO CHANGE!

     

     

     

    with any insurance companies as a prefered provider including with MEDICARE PART B. He has signed a letter with Medicare to Opt-Out of Medicare. This means that patients need to be informed that they will not receive benefits from Medicare and the office is not allowed to file to Medicare.

    Instead, the patient is asked to sign an OPT-OUT LETTER OF AGREEMENT which acknowleges that the office does not participate. 

    We will still need a copy of the medicare card to send to the lab for them to file to Medicare should a biopsy be performed.

  • MEDICAL INSURANCE - FEDERAL EMPLOYEE PLANS:

    Impacted Wisdom Teeth are STILL covered under many FEDERAL MEDICAL INSURANCE plans. It is extremely rare for a medical plan to cover impacted wisdom teeth and other oral surgery - so this is a great benefit! 

    Dr. Alman is NOT a perferred provider for any insurance plans. However, we do help by filing for you to be reimbursed according to the out-of-network benefits as available. For wisdom teeth, we have been finding that the payments have been up to 85% or more of our fees! If you have dental insurance in addition to the medical insurance we will file this as well.

    • Some Federal plans require 2 or more impacted teeth in order for the medical insurance coverage to apply.
    • Erupted teeth are not covered under the medical plans - instead once erupted, the teeth are only covered under a dental plan.
    • Anesthesia will also be covered if the teeth are impacted (2 or more).
    • Another great benefit is that the medical insurance does not have a annual maximum that dental plans have.
    • Please call your insurance company to verify your benefits. We will provide an estimate with the codes to assist you. However, we find that asking "Is impacted wisdom teeth covered under my medical plan?" is sufficient.

     

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  • DENTAL INSURANCE:

    Oral surgery procedures may be covered by dental insurance. Dr. Alman is NOT a perferred provider for any insurance plans. HMOs & Discount Plans do not have any out of network benefits.

    If you have coverage has out-of-network benefits we will be pleased to assist by filing a claim on your behalf. We are filing for you to be reimbursed according to the out-of-network benefits available.

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  • Your Physician's Contact Information may be needed to contact them for medical clearance or medical manaagment. If you see multiple specialists please gather their information as well for later at the end of this form add each Name, Specialty, Telephone Number, Email, and Fax Number. We don't need the address but, the City, and State is appreciated.

  • Aspirin (or Baby Aspirin) causes bleeding issues.

    If you are taking either Aspirin or Baby Aspirin on your own (not prescribed by your physician) please stop taking it 7 days before your procedure. If you have any questions please consult your medical doctor. 

  • Since the patient is taking a blood thinner/anti-collagulant, Medical management/clearance must be obtained before an oral surgery procedure can be performed.

    We have a form for either you to complete or the physician. This way we will have medical involvement as to the stopping and restarting of medications or directions to not make any medication changes. Most importantly we will have medical approval to proceed with an in-office procedure.

    This form is located on our website dentalsurgerymd.com. If you have any questions please call our office.

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  • Patients who are currently taking or have taken bone density medications need medical clearance before having oral sugery. We have a medical management/clearance form on the website.

    The website is dentalsurgerymd.com.

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  • Some Health Problems or Conditions may require Medical Management or Clearance for an In-Office Oral Surgery Procedure. 

    Please detail your problem or condition. If Medical Managment or Clearance may be necessary.

    We have a medical management/clearance form on the website.

    The website is dentalsurgerymd.com.

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  • WARNING! ANTIBIOTICS (example: penicillin) may render Birth Control Pills ineffective. Consult your obgyn or physician for advise and alternative birth control.

  • Travel plans need to be considered when scheduling oral surgery procedures. Often we try to have patients nearby for a week or longer after a surgery in case there is a post operative concern. Please discuss this with our office when scheduling. 

  • Athletic activity may need to be avoided after oral surgery.

    For some surgerical procedures raising the head blood pressure may cause bleeding or lose of a blood clot - we generally as for patients to avoid excercising, lifting weights, or even bending down for 48 hours. 

    Other sugical procedures may require refraining for an even longer period but, not typically so.

    Some sports may involve the potential for head interaction/contact. Please let us know if you are involved in a sport that may fit this discription.

  • Swimming should be avoided for a minimum of 3 days after oral surgery. Dr. Alman would prefer 5 days. The concern is questionably clean water and open wounds. Please call our office if you have any questions.

  • Both wind instruments and singing involve using the muscles of the mouth.

    Some procedures especially the removal of several wisdom teeth may cause jaw stiffness and or muscle fatigue or soreness.

    Dr. Alman generally asks patients to avoid both playing a wind instrument or singing for a week after surgery. Other sugical procedures may require refraining for an even longer period but, not typically so.

    Please call our office if you have any questions.

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