@jlehman56 Hello jlehman56. I never went through an appeals process personally. My doctor (a neurologist who specializes in treating RLS) wrote my Rx for Nidra and it was approved without any fuss. I qualified because I had tried a litany of RLS medications with only partial relief and I have really, really bad RLS (which presents as pain). That scenario must have been captured on how he wrote my Rx, although he told me that some of his other patients were denied Nidra (which puzzled him).

What I posted on this forum was that I read in an AARP Magazine that patients who were denied medical services or equipment should appeal. I may have mentioned the issue and page of the AARP Magazine that said this. My husband also read that the majority of appeals are successful.

It does seem like denials stem from the bureaucracy attempting to save money in their systems by saying "no" whenever possible (rather than carefully considering each case).

My guess (not based on personal experience) is that successful appeals could depend on having your doctor involved, willing to write something to justify insurance taking another look as the basis of getting approval.

Nidra's manufacturer (Noctrix) is a relatively new company and Nidra is a relatively new device. They (at the company) could be helpful in launching an appeal. I suggest you call them (you can google their phone number--they are based in California--Noctrix Company). They have a vested (monetary) interest in RLS sufferers being approved for Nidra and they have experience with who has been approved. I think they could provide specific guidance for you.

I understand your wariness in signing something you don't fully understand. I would feel the same way.

While Nidra doesn't help everyone who has tried it (according to my doctor), for me it was a miracle. That is why I have posted singing its praises.

Please do let others know your progress and what you learn (about appealing an insurance denial). There are others reading this board who are very interested.

I wish you success!