As I have tried to be treated by LCA, and got a 3D model of the head and a little more health for the money

Situation that probably encountered many owners VHI policy with payment of dentistry, when the insurance refuses to pay for the treatment of a tooth. The dentist sends the aggravation home - "make an appointment", not saying a word about the fact that following the reception and treatment are not insurance.






In this note we tell you how it was possible to make CT jaw to disk, what data format DICOM and by what open source programs can work with it. And how and where I could find dental care.


Maybe you do not care about the history of the communication with the insurance company, and be interesting to know just about used software and DICOM

Most of the story made me angry that I was not informed at the first dentist consultation on February 19 about the diagnosis, prognosis - the fact that long-term treatment and will be held at my expense and not a fact that will help. Came up with swollen gums, I was sent to an X-ray study. Brought snapshot doctor asked to wait under study. Nurse came out and said, "You have a problem with the root of the tooth should be treated. To make an appointment! "Going on vacation for a week from Moscow. Immediately upon return, make an appointment to her colleague, which up to this one and a half years ago was at the reception and treatment.

After the second dose, only that I was informed that all treatment will be at my expense, called the call center insurance. Wanted to find out whether the dentist was not mistaken. Immediately warned that in order to improve the quality of service I record the conversation Trying to find out the reason why I was not given medical assistance insurance. In the first conversation I offered to give the phone a doctor, even though I called home. An insurance offered yourself to make a request to the clinic, to this point, all interaction insurance - health facility took place without my participation. After that I was asked to wait and said that the proposal adopted and staff will review it next week and will contact me. I left a request on February 27, the day of the second reception.

March 10th I called the call center to know the results of the insurance. And I need to continue treatment. I was told that the system has my application, but the staff are not yet engaged and she will soon start its implementation. There followed a reasonable question why for the whole working week no it was not engaged. After that, I was transferred to the line supervisor.

The curator said that the clinic does not give access to my medical card. After questioning her and questions what exactly do I do to continue the treatment, I was recommended to make an appointment to the same dentist, and when I come, give her a call and give the phone a doctor. I signed up on the phone at the reception.

The next day I called the supervisor and told the doctor she phoned the insurance. That the tooth is destroyed by more than 50%, and therefore it is not an insurance case and that I asked not at the time of exacerbation. I knew that at the time of treatment the tooth was depulpirovat, but not on the floor seal tooth. Then I asked why I was sent to the time of exacerbation recorded on another welcome and provided assistance. I began to ask questions about how to determine more or less than 50% of one-shot?) Got no answer, I repeated the mantra that the case is not insurance and the doctor takes the decision. But it is recommended to continue treatment and still go to the reception. I called the clinic and canceled the appointment in advance.

Ask an Expert Support Department of the insurance company, where copies of the letters were ladies of administrative staff with my work dealing with insurances employees.
My letter to the insurance

Why is the objective characteristics of the aggravation I was not given medical assistance under a contract with the LCA of my complaints of swelling in the gums 36 tooth pain when biting and aching for a week prior to receiving, bleeding gums. Why insurance company supervised violation of the insured on the treatment and provided no objective evidence to refuse service under the contract?

On the basis of any objective data the insurance company and the doctor make conclusions about tooth filling, as calculated more or less than 50% of this volume filling the entire tooth fillings mass, volume seals around the tooth or just the crown of the tooth? As this conclusion was carried out and documented as you confirm it? Was made only one projection X-ray! I'm wondering how to behave in a similar situation in the future, when for some reason the doctor is interested in the work is not at the expense of the insurance company, but at the expense of the patient. I did not find this item in their contract about treatment and over 50% of tooth filling.
Blockquote>

In response, sent word from the insurance document with the application to the contract that I had to sign and send the scan.

A brief excerpt of interesting items:
The insurer can process my personal data for the Insurance Contract, as well as within 25 (twenty five) years after its termination < /. provides the insurer with the right to perform all actions with my personal data ​​li> This consent is given at the time of signing the Agreement and is valid indefinitely I know that I have the right at any time to withdraw your consent by sending written notice to the Insurer, which shall be sent to his address by registered letter with acknowledgment of receipt or delivered in person against receipt representative of the insurer. I know and agree that the insurer is entitled to consider such notice as my expression of the will to terminate the Agreement in relation to me, and therefore I will be removed from the Insurance Agreement within 3 days of receipt of the notification .


Summary: if you do not like that you can do with your presonalnymi data in the next 25 years than it should be indefinitely agree, then we will stop your service under the contract ...

I posted this agreement as drafted, that I allow to make the necessary steps for their work with my data under this contract LCA, including to verify the quality of health care under the insurance contract.

Wrote that went to the clinic talked to the administrative officer in the clinic on the insurance company access to my medical card and treatment information. I was assured that every week a representative of the insurance company comes to them and gain access to the medical history of their clients. I asked whether I need to write a letter requesting access to my honey. map, and received the answer that the insurance company and so has the necessary access to medical history.

Received the following answer:

Igor, the fact that this agreement is an integral part of the contract LCA and should be signed in the form in which it is applied to the contract at the time of entry into force. Blockquote> Reassure period!

Trying to bring to correspondence with a lawyer does not work helped me with the treatment for LCA. Okay, дареному horse - in the teeth do not look , I will figure out how not to get trapped in the future and try to find quality care on their own. First found interesting article about motivation dentists and insurance companies, and in several forums correspondence doctors and patients describe almost the same problems.

I went to the clinic, took statements from the card paid services - a certified photocopy of the seal clinics. But the initial reception was in the map by LCA and I was sent to the same doctor who did not treat me with aggravation. 2m dentists in this clinic I do not trust. Map it delivered, but I did not photocopy pages from the card, and the printer is printing text printing doctor. We did not have a shot (and did not make a copy), which I would be able to continue treatment at another hospital. I read an extract & quot; ... seal tooth 36 is greater than 50%. ... Recommended: revision of channels 36 through the patient's teeth & quot ;. Interestingly, it was telepathic recommendation !? I do not have articulated and writing were not given. The problem with this situation, in my opinion, is not in the objective data about that more or less 50% of the tooth is destroyed, and the original motivation and approach to the patient under this insurance at the doctor and insurance.

It was a temporary filling, exacerbation could start again from day to day. Here I am with extracts, and even without a picture of the tooth root. Where to go for treatment?

I do not know about you, but I do not believe private clinics in Moscow. Usually visit their ends with the sentence to be tested for and treated 15tr from lupus erythematosus (hello Dr. House) or by helicobacter pylori - no matter how the complaint originally came.

Therefore, armed with a search engine, began to view the state dental clinics. My choice fell on
Central Research Institute of Dentistry and Maxillofacial Surgery - FGBU "TsNIISiChLH» . Chose them after studying their website, the price list and scientific publications. The hope was that the qualifications of doctors in one of the leading Research Institute of Dentistry corresponds to the status institutions, and treatment is based on modern techniques. It was interesting to read even the thesis of the doctor at the clinic on the Internet about the analysis of X-rays of the teeth and their roots CT, processing statistics on the results of treatment, etc.

Has called on Saturday, spoke with an employee at the front desk. Said that the examinations over the destruction of the tooth they do not, computed tomography operates on weekdays, but it is better to ring and learn as Imaging lately is not running. Home print a list of several honey. institutions to CT jaw.

On Monday, slept badly - started worsening. On Tuesday morning, with swollen gums, came to do CNIIS CT ​​at their own expense before receiving the dentist. Scanner is not working, called CT in Sechenov Institute and worked there.

Went to Kaluga in "Russian Research Center of Radiology» ( RNTSRR ), call me back and failed. And I realized why - there were queues in a dozen other windows, so many people were waiting for their turn. I suppose that from across the country: some surveyed, someone treated. Benefit there was electronic queue After an hour and a half I was able to first enroll in one window and make a card, and the other to pay for the survey. Despite the huge queues and nervousness of people in them, the employee were very polite Enrolled me for examination only on free window at 4 pm that day. But as it turned out, almost immediately after the payment I would be able to do CT, a staff member at the front desk did not know about it. In the evening, take time off from work and went to do CT scans of the mandible.

Doctor and nurse were very polite and nice young lady. They have been the end of the day, empty under study and were only waiting for me to write. With the conclusion of the printouts and the results would be ready the next day, and I could not wait another day - gums hurt. Asked only write to the media and through the 15-20 minutes I got pictures on a DVD disc.

The results rushed to the clinic CNIIS to catch up to the end of the working day. I learned that my program LCA acts for them and went to see a therapist, dentist complaining of pain. I was pleasantly surprised by the attitude. Told the doctor about his misadventures with the insurance showed swollen gums and tooth unfortunate, showed all the statements that I have had. Said that I have to have a CD with the CT study. But as it turned out the computer in the office was not his colleagues on the floor too. We went to a doctor radiologist to another floor. On that day, not only worked scanner, but the computer and software in the office was not defective. So I was lucky! Lucky, but not quite ... Drive very slowly readable.
And until the end of the day this department had little time. I was sent to do another picture of the tooth. After 20 minutes, the same doctor came from colleagues sad. Here I tensed. What can be frustrating physician at the Research Institute !? But it turned out that just does not make sense to treat a tooth on the results of CT - volume of the cyst is large enough, it comes under the center of the tooth and the tooth is cracked. Remove the tooth in this case the best option. I relaxed here already that I'll live)))

The doctor went to surgeons to another floor and consulted with them. Wrote a report and sent me to remove. In my case, the doctor spent about an hour, went from floor to floor. For me, this was very unusual care and attempt to understand my problem. The professionalism of the doctor and the ratio was pleasantly surprised !!!

Prior to removal of the tooth and the cyst, waited about half an hour in the registry insurance solutions on the payment of treatment. It was at the end of the day !!! Removing paid, and filling bone defect jaw biocomposite material refused to pay. Remembering savings insurance kind words, I paid through cash 1750rub. to reduce the risk of complications after surgery and to speed up the recovery process of the jaw.

Removal was difficult, did not give the tooth, root broke during removal. Anesthesia allowed to observe the process without fear) Thank you doctor and his colleagues , they stayed after work for another 20 minutes to finish their work. Clean cyst filled with biocomposite material after removal, nurse sewed gum. A week later went took seams, another doctor gave me recommendations, read the small lekbez on the anatomy of the jaw and how to brush your teeth)

My friend recommended not to delay the continuation of treatment and put the implant, if decided. It is already completely at my expense. It just makes crowns, gave advice and talked about the fact that when there is no load on the jaw in place of the removed tooth and jaw bone thinning deformed. I will put the implant, do not want to die like a старый Elephant who have worn teeth;-)


All images in this article are prepared with the help of open source software.

A little about the data format: DICOM - standardized format exchange of medical information and meta-information. At the exit of the CT scanner is the most standard that is! Just in this format asked to record the results of CT on the disc.

Program InVesalius - for 3D reconstruction from DICOM images. Fairly simple to use and not as versatile as 3D slicer. But lets get results quickly. So I got a 3D model of the face, rotate your skull in the viewport and exclaimed "poor Yorick!".



3D slicer much more functional than the package InVesalius. 3D slicer for medical scientists as Blender for 3D graphics. Functional, but we need to spend time learning. I do not have much free time and desire to delve into this software. Better, I will continue to write articles about aspect-oriented programming , and these programs will leave medical students and scientists. For me surprise that so many health programs are in open source !!!



The picture was taken after the second receiving and removing old fillings and tooth tissues damaged by visual inspection tooth destroyed less than 50%
It should be a temporary filling, but it has already begun to break down. B>




Animation of "slices" of the tooth and cyst MRI



Imagemagic used for framing and raster animation gif collection of individual images, as well as command-line tool from the package dcm2pnm dcmtk: OFFIS DICOM toolkit command line utilities
dcm2pnm to extract data from a raster format DICOM

 & lt; code class = & quot; bash & quot; & gt; convert -delay 100 -loop 0 * .pnm animate.gif & lt; / code & gt;  pre> 
 Manual process of segmenting the image of the tooth 36 on RT InVesalius very similar to the process of creating a mask brush in a bitmap editor.


Automatic segmentation of image capture all the bone tissue in images and therefore can not come. If it is interesting to record a screencast creation process model, write in comments.

At the end of this session, has made a 3D model of the coronal portion of the tooth 36 after segmentation manually slice tomography.
After treatment, tooth for your counters is the same amount as in the photo above. Interface InVesalius


I wonder whether other patients managed in such a situation to prove the true extent of tooth decay. Does any such examination clinic? Theoretically, the model of the tooth can be objective argument in a dispute with the insurance. In my opinion a great topic for a dissertation dentist !!!

LCA dispute c I did not win, because the tooth did not make sense to treat. But thanks to this dispute and attempt to cure a tooth, I saved your health, learned a little more about insurance medicine, met with open source scientific software and medical institutions found in Moscow where I was not afraid to be examined and treated.

I hope that this experience will help you stay healthy, and someone and win in a dispute with the insurance company!

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