@lk8

Hey there! I would not accept anything until you are sure you are approved. Call your doctor back. His nurse will get you preapproval of either let you know you are not approved. Hopefully, you will get approved and have great success! I am so pleased. Only been on since April 2026. Good luck!

kdunn44

@lk8 Why don't you call the Noctrix Company (it's in California--it's address and phone number can be googled)? They make the Nidra, so "sales" are in the best interest in the company. From my limited knowledge, it seems a number of insurance claims have been denied. Noctrix will have the best handle on how to deal with insurance and they (for me) have been incredibly nice and helpful when I communicated with them. (You probably read that I'm one of Nidra's success stories from my postings--I hope you get the device and I hope it is equally effective for you).

@lk8 After my last post, I put my husband to work--looking for the answer to why Nidra is denied by Medicare. He found (on some FDA or Medicare website) that approvals are based on medication being trying and not working adequately. My medication helped prior to Nidra, but my symptoms continued and were still significant. It sounds like that kind of a scenario needs to be expressed when Nidra is prescribed. I hope this is helpful information.

Ugh, @lk8, that's so frustrating with Medicare. I'm fairly new here, but I've dealt with RLS for years and insurance issues like this are always a headache. You absolutely don't want to just say yes and hope for the best, especially with a device.

When you're looking at a new device like Nidra, sometimes the company that makes it has a patient advocate or a dedicated billing specialist. They often know the specific codes and how to talk to Medicare about their product. I would definitely ask the Nidra consultant if they have someone like that.

They should be able to help you get a written pre-determination. That's what you really need to avoid a surprise bill. It's also a good idea to keep a log of everyone you talk to, their names, and what they say. Getting clarity on coverage is so important before you move forward.

@lk8, I'm so sorry you're still hitting a wall with Medicare. It's incredibly frustrating when you can't get a straight answer, and it makes total sense you don't want a surprise bill.

To your question about just saying yes and hoping for the best, please don't! It's really tough to get pre-approval sometimes, especially with devices. Medicare reps often don't have the specific codes or experience with a newer device like Nidra. That's why pushing the Nidra consultant for their dedicated billing person or advocate is so crucial. They're the ones who know exactly how to speak Medicare's language for their product, and they should be able to get you that written pre-determination.