Here's my story.
After finishing my residency in Canada I moved to Great Falls, MT in 1988 and practiced there as a solo neurosurgeon (community had 3 other solo Neurosurgeons as well) until 2001. Then I moved to Kentucky and am now in solo practice in Elizabethtown, about 40 minutes south of Louisville. It seems I like small cities.
Anyway, I had various left-ear symptoms for many, many years (episodic sharp pain inside ear canal, episodic high pitched sounds and episodic fluttering) but it was early in the 1990's that I began to have the contractions on the outer aspect of my eye, and then I realized the diagnosis was HFS. In retrospect, the earlier pains actually represented geniculate neuralgia (signaling involvement of the nervus intermedius, a tiny slip of a nerve which sits between the 7th. and 8th. nerves), while the high pitched sounds were probably due to involvement of the 8th. nerve (auditory nerve). As you may know, the flutter in the ear is caused by spasms of a little muscle in the ear called the stapedius, which receives its nerve supply from the 7th. nerve. (The stapedius muscle tenses up the eardrum). So I was a practicing Neurosurgeon before I recognized my symptoms as due to HFS, but in retrospect my symptoms began years earlier. Anyway, I just put up with the spasms for a couple of years (I think my glasses obscured them), then began with Botox. The Botox helped really well the first time, hardly well the 2nd. time and never thereafter. By 2000 I was fed up with the constant spasming which by now created a tonic sustained contraction involving the left side of my face, which made my face ache all the time; additionally, my left eye was nearly closed, which gave me monocular vision, and that was not good for a surgeon. So, after asking around with some colleagues both in Canada and the U.S., I simply gave Tony Kauffman a call. He was at the Foothills Hospital in Calgary, Alberta at the time. I explained who I was, where I lived (only a 5 hour car ride away), and what my symptoms had been doing over the years, that I'd gone to Botox route but now was prepared for the MVD. That was February 2000; he said "Fine, I'll book you for April 23." And he did. I got my MR scan and blood work done in Great Falls just before I drove to Calgary, met him that day, had surgery the next day, and was discharged the day after. I stayed with a friend (and my little dog--gotta have that emotional support!) in a nearby motel, and drove back to Montana 2 days later. On my way back south I dropped in to the hospital because I hadn't actually seen Tony since the surgery (his residents had made rounds on me post-op and the day of discharge). He popped out between cases, checked me out and that was it. I KNOW HE DOES NOT TREAT HIS PATIENTS WHO ARE NOT SURGEONS in this apparently casual way. To tell the truth, doctors (like nurses) make terrible patients and hate being in hospital. It was I who insisted on being discharged the first day post-op. The resident was very uneasy letting me go without the attending (Kaufmann) having seen me, and he said he had never let a posterior fossa crani patient go on the first day, so I can understand his reluctance. But I like to get my own way: I told him I had never sent a post. fossa home the first day either, but if were going to do it, I'd be the right one! That was the last contact I had with Tony until very recently, when I sent him an email to let him know how things were going. Which is perfect--still SPASM FREE. My insurer at the time was Mutual of Omaha, and it was a standard indemnity policy with a $5000 deductible. They never gave me one second of trouble. I called them up and said I was going to Calgary in Canada to have elective brain surgery, and would my policy cover it. They said yes and I had them send me a letter confirming that it was covered. All I had to do was meet my deductible and that was it. The surgeon and anesthetist submitted separate bills, and the hospital submitted one bill. The total of those three bills was way less than US$10,000. Remember though that all the pre-op studies had already been done, so it was only operating room time + supplies, a one night ICU stay, and the 2 doctors' fees. Cranial nerve monitoring was included in the OR bill. I'm sure my insurer was overjoyed. US patients with HMO or PPO would have to undergo pre-certification, but providing the diagnosis of HFS had already been established and it was known that no other (e.g. medical/Botox) treatment was effective, then if surgery is the treatment, and the surgeon recommends surgery, and the patient accepts the risks of surgery, then the insurer can not refuse. Patients need to remember that the insurance company is not allowed to make medical decisions; the doctors and patients do that. The insurer is there to pay the bill according to the contractual obligation between the patient and insurer.