Nidra TOMAC device

Hi there,
I just discovered this thread. My doctor submitted the prescription for the Nidra and the company has called me to set it up. However, even with 3 phone calls to Medicare, I can't get any verification that it will be covered. I've had RlS for years and I'm on pregabalin and ropinirole. My doc doesn't want to increase the ropinirole any higher. When I gave the medicare persons the codes and the provider number, they couldn't find anything. Do I just say yes to the Nidra consultant and hope for the best? I don't want a huge bill if it's not covered. Why can't I get a pre-approval?
thank you!

Hi there,
I just discovered this thread. My doctor submitted the prescription for the Nidra and the company has called me to set it up. However, even with 3 phone calls to Medicare, I can't get any verification that it will be covered. I've had RlS for years and I'm on pregabalin and ropinirole. My doc doesn't want to increase the ropinirole any higher. When I gave the medicare persons the codes and the provider number, they couldn't find anything. Do I just say yes to the Nidra consultant and hope for the best? I don't want a huge bill if it's not covered. Why can't I get a pre-approval?
thank you!

@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).

@missjb thanks for your reply. I have called the Noctrix company several times and Summer keeps saying that Noctrix has been approved by medicare and that they do NOT do pre-approvals. She also said that 'their' nurse approved my prescription. I told her to go ahead and send it to me and if medicare doesn't approve it, I will send it back and I will not pay for anything. She said that would be fine, but I have nothing in writing. My concern is that I've heard so many are denied.

Hi there,
I just discovered this thread. My doctor submitted the prescription for the Nidra and the company has called me to set it up. However, even with 3 phone calls to Medicare, I can't get any verification that it will be covered. I've had RlS for years and I'm on pregabalin and ropinirole. My doc doesn't want to increase the ropinirole any higher. When I gave the medicare persons the codes and the provider number, they couldn't find anything. Do I just say yes to the Nidra consultant and hope for the best? I don't want a huge bill if it's not covered. Why can't I get a pre-approval?
thank you!

@lk8 Pre-approval was not part of the process when I got Nidra.

My perception is "approval" has been an issue for some people. Initially, I got this impression from the Noctrix nurse I spoke with. She said it was important that the prescribing doctor include patient history--which someone at the Noctrix Co was going to evaluate. Maybe, this was because Noctrix wanted to build a good reputation with Medicare--only have qualified patients apply for insurance funding.

My doctor evidently did this acceptably because it was only a matter of 3 weeks between submission of the prescription and picking mine up.

Or, maybe Medicare looks at past billing related to RLS to see if there is history. I don't know how insurance works--deciding to approve or deny. But, I did have years of Medicare billing specifically for RLS care.

In general, I have read that all insurances deny some claims and that appealing is successful more times than not.

Most of my contact with Noctrix has been email--you could call one more time and ask Summer (or someone) to email what was said over the phone (give her your email or ask for hers) and then you would have this verbal agreement in writing. (Emails count in a legal sense as much as a paper letter).

I can understand the possible expense making you nervous--particularly not knowing if Nidra will work for you (until you try it).

Really, I think the company is trying to build a good reputation, and they will stand by what Summer told you.

My sense of Noctrix from the support I have been given is that they are honorable. I wouldn't post about them in glowing terms if my experience hadn't been so good. Also, I googled the Noctrix board a year ago and I was impressed with their resumes. I don't remember exact details but schools like MIT and Stanford come to mind.

My own experience was getting an email address somehow (after I read about Nidra in research articles) and then having a phone call with a nurse, who explained Nidra was only available in certain states, but not where I live--yet. I said I could travel to a state where it was available (Ohio), but she said it still wasn't possible. A year later, Noctrix contacted me and gave me permission to start the prescription process and then pick mine up in Ohio. I was very impressed that someone in the company followed up (without any prompting from me)--an entire year later.

My doctor did mention that some of his patients have been denied Nidra approval by insurance. But I have no idea how this looks in actual numbers. Is it "many" or does my doctor just think all his prescriptions should be approved (he is a RLS expert--so, really, they should).

I'm going to start a thread for people with Nidra so we can compare our Nidra experiences and maybe be helpful to people just starting out (like you will be). For me, there was a process of getting used to it. Then, the neuromodulation (change in my brain, reducing the frequency and severity) was months and months in coming.

Some people do not have the success I have had. I hope, lk8, that you will. Please do keep us posted!

Hi again, mikayla68

I laughed out loud reading "do you work for Nidra?" I'm several years older than you are and I work for no one --except my husband on occasion and truthfully, when my RLS was really bad and I was so sleep deprived, he did almost all of the work in our household.

My relationship with the Noctrix Company (that makes the Nidra) is purely one of gratitude. I mention Nidra on our forum with enthusiasm because, for me, Nidra (along with medication) has reduced my amount of RLS symptoms to very, very few--which has given me back my ability to sleep. ..I wish I could also get back the last 15 years... but that's another story--sleep is so much better, but now age is catching up with me.

I suggest people contact the Noctrix Company with questions or problems because my communication with them was so favorable--not because I have any connection to them (except as one of their many customers).

It sounds like the Nidra made your calf muscles contract and then get locked into contractions--which does sound very painful. Bad enough to have one problem--you don't need to trade that problem for another (particularly one which is worse.)

During my last conversation with my doctor he told me that he has prescribed the Nidra for patients who received no benefit from it. Stuff like that makes me curious: why has it helped me (so much) and then not all other people who suffer for RLS?

Well, I think your doctor was forward thinking to have prescribed the Nidra, even though it was not helpful for you. Hopefully, this means he (or she) will continue to try treatments and maybe find something that gives you as much relief as I have now. I certainly hope so.

Thank you for sharing your experience.

Wishing you the best!