Does Dr. Filler accept insurance?

[Karyn]

Hi Bishop!
Have you checked out our list of PN doctors? Were you considering Filler because of his proximity to you? Although you'll probably still have to travel, it would be helpful to know your location in order to direct you.
Warm regards,
Karyn

[mmr100]

Also, he claims to have a 90% success rate with his pudendal surgery. If that were true, his near-certain cure would be written up in medical journals and all other doctors would be copying his success.

Well, actually his procedure *is* published in respectable medical journals, along with details of how he reaches his figure of 87\% of patients experiencing improvement:

Neursurg. Focus vol. 26 E9 2009

"The good to excellent outcome rate
(improvement of ≥ 4 on the 10-point analog scale) was
68% at 3 months posttreatment and was sustained after 1
year of follow-up in 87% of those patients in whom 1-year
data were available. The improved success rate at 1 year
posttreatment relative to the rate at 3 months was attributable
to the slow, steady improvement after 3 months; e.g.,
patients reported 0–3 points improvement at 3 months but
> 4 points at 1 year."

He has an older paper (2008) as well, that lacks the 1 year follow up, but is otherwise pretty much identical in content.
Of course, he seems to neglect to mention exactly how many patients provided data at 1 year, which makes that 87\% a little suspect. Only in the medical field would that omission get through peer review, but such are the standards.

Don't get me wrong, I don't really object to your comments, but credit where credit is due -- Filler is one of the few MDs actively publishing and developing techniques in this field. True, Hibner has a recent (2010) article, but he really just rehashes the procedure of Robert et al. which, lets be honest, doesn't have a huge amount of statistics to back up its efficacy either. Moreover Filler's objections to the transgluteal approach (as stated in his paper), are fair and his method does remove the risks he cites, though perhaps at the expense of introducing others. As for other surgeons using Filler's approach -- the reality is that very few surgeons working on PNE have the training required to perform neuroplasty laproscopically in such a difficult area. Filler has those skills, so he uses them. Unfortunately, as no one will ever do a large scale controlled and blinded study on such a rare problem, we will never really have the data required to compare approaches and surgeons objectively.

As an aside, one of the most interesting aspects of the paper is Filler's claim that only $\approx 5\%$ of his patients had entrapments at the ischial spine -- where most PNE surgeons believe that the majority of entrapments occur. On the contrary, Filler claims that just under 80\% of his patients are entrapped in Alcock's canal on the medial surface of the obturator internus. If true, that's very interesting and is consistent with one of the original studies on this problem done back in 1988 that looked at high mileage cyclists.

[AliPasha1]

That is very contrary to other PNE publications.80% of the entrapments are either in the ST/SS ligament grip while the rest 20% are entrapped in the Alcock's Canal.If Dr. Filler's claims and publications were true,I would sincerely think everybody would be knocking on his door.We have so many cases here who didn't have benefit from Filler and are either going to Hibner or Bautrant for redo surgeries.

[mmr100]

That is very contrary to other PNE publications.80% of the entrapments are either in the ST/SS ligament grip while the rest 20% are entrapped in the Alcock's Canal.If Dr. Filler's claims and publications were true,I would sincerely think everybody would be knocking on his door.We have so many cases here who didn't have benefit from Filler and are either going to Hibner or Bautrant for redo surgeries.

Yes, it does seem that the majority of surgeons practicing in this field believe that the major problem is entrapment in the ligaments at the ischial spine. However, to be honest, my review of the (unfortunately sparse) literature on this subject did not reveal a great deal of evidence to support this. Also many surgeons, particularly those using the transgluteal approach, seem to sacrifice one of the ligaments and try to release the nerve in Alcock's canal as well. Consequently, it's hard to see how one can conclusively point to the ischial spine or Alcock's canal as the site of the problem on the basis of their results. That was one of the interesting aspects of Filler's papers, he did provide hard numbers on the points and frequencies of entrapments and was able to do so due to the highly localized treatment approach. However, as someone suffering from this dreadful problem, I'd be very interested reading the papers that provide evidence contrary to Filler's results. Could you please give me the reference where you found the 80/20 distribution you cite?

Also, just to be clear, I'm not trying to do a sales job on Filler and his surgery -- the sample sizes for *every single surgeon* working on PNE problems are so small that it's really hard to say anything conclusive. However, I'd be careful implying that Filler's papers are untrue -- basically that would suggest either (a) he's incompetent (and based on his research and clinical background that's very hard to believe) or (b) he's willfully engaging in scholarly misconduct, and that is an extremely serious accusation. It is entirely possible however that his numbers aren't representative -- a sample size of approximately 190 isn't very large, and his patient group was self-selected. These factors are ackknowledged in his paper, and of course the same issues plague everyone else in this field. For example, for all we know Filler has been dealing with a horde of former compulsive cyclists who rode on bad saddles, and for that type of patient population, issues in Alcock's canal may be more probable than issues at the ischial spine.

I'll also point out that the fact that you have many cases who didn't benefit from the work of a particular surgeon is not really something you'd want to base a decision on, as it is a classic example of sample bias. The surgeon in question could be excellent, however you are unlikely to hear as much from the people who benefited from her work as you are from those who didn't, and every surgeon has her failures (some more vocal than others). Moreover, the small sample problem arises in this context as well; surgeon A may just have wound up with a larger fraction of difficult cases than surgeon B. Remember, we are not dealing with a very large patient population here, so expect outliers to have a large effect. Unfortunately, that doesn't leave people struggling with this problem with much objective data to go on, so if someone is just personally more comfortable with surgeon A than surgeon B, then that should probably be the deciding factor.

Honestly what we need, and perhaps this website can encourage, is for *all* the surgeons working in this field to pool their diagnostic data and surgical results, and then collectively *PUBLISH* (in english, in a major journal). With the larger sample size, we *might* start to see statistically meaningful trends (more so with the diagnostic data than the surgical results due to the variety of surgical approaches being used).

[ezer]

I do agree with you mmr100. I think that Filler's papers are serious and the MRN is real technology not just a gimmick.
Also the injections are very expensive because Dr.Filler uses his own open MRI to do an accurate job with the maximum safety for his patients. Such an expensive machine has to be amortized.

Moreover Filler's objections to the transgluteal approach (as stated in his paper), are fair and his method does remove the risks he cites, though perhaps at the expense of introducing others.

mmr100,
I am curious to know what other problems you are alluding too. Could you elaborate?

[Charlie]

I agree that the sample sizes for Fillers studies are small. However find me a study in the field of pelvic pain that does not have a small sample size.

Fillers studies are peer reviewed although I don't think that counts for a lot.

http://journals.lww.com/neurosurgery-qu ... e=abstract

If you email Fillers office they will email you both of his papers on PNE.

[Karyn]

In this issue
Exclusive: FaceTime with Dr. Filler and his staff
Welcome to the March Newsletter

The entire staff of the Institute for Nerve Medicine welcomes you to our March 2011 Case Study and Newsletter.
Well, I thought this was kinda interesting! No wonder he charges so much! How else could he possibly afford iPod for his patients?!?

INM FaceTime Program for Surgical Patients

As you can see to the right, we are launching our FaceTime Program for surgical patients.

Every patient who completes a surgery with Dr. Aaron G. Filler will receive a specially configured Apple iPod Touch with FaceTime video chat software. This will allow the patient to schedule and receive video chats with Dr. Filler and his surgical staff throughout the post-operative recovery period.

INM provides the best level of care, before, during and after surgery. The FaceTime Program for surgical patients is one more example of how we place patient care above all else.

Call us today at 310-314-6410 to learn more, or click here to inquire with our Surgery Coordinator.

[Celeste]

No wonder he charges so much! How else could he possibly afford iPod for his patients?!?

Every patient who completes a surgery with Dr. Aaron G. Filler will receive a specially configured Apple iPod Touch with FaceTime video chat software.

It might only be the $229 8GB model...but still, the patient definitely pays for it, wouldn't you say? Makes me wonder if he gets a price break for defacto advertisement of a brand like that. I'm also sure that the patient has to cover their own internet service as well. Maybe not such a gift when you think about it.

[pianogal]

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[A's Mommy]

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