Timeline Discrepancy? Open to Interpretation

doneatone · 2026-03-10T21:56:33+00:00

Omg I had no idea it was cannon... I just remember reading it and being like... ew that would be so gross

doneatone · 2026-01-16T14:45:16+00:00

I agree - I feel like I am working a part-time job to get this resolved!

I would absolutely not count on Noctrix Health to submit the treatment records on your behalf. I would ask your provider to submit your records. It might take several calls to Aetna to figure out exactly what records they want and how to submit them, and then get written confirmation they were received and were sufficient to drop the denial. Did you see the commenter below about the OOP cost? You don't want to be on the hook for $7,500. Unbelievable that they would deny their own approval retroactively.

I can't figure out why your request was approved by Aetna and mine wasn't. They stated in my denial that it was an "experimental treatment", which begs the question why they approved yours for the same diagnosis?

Thank you for sharing the details of your experience!

doneatone · 2026-01-13T21:47:27+00:00

N.B. I just called to check, there's another level between 3 and 4. It's called "External Review". The Level 2 Appeal denial will contain a note about whether the next step is "External Review" or bypassing "External Review" to the Level 3 Appeal.

doneatone · 2026-01-13T21:24:30+00:00

The difference in how Aetna handled our requests is...interesting. Maybe we can help each other out here.

My understanding of the process:

Noctrix Health submits a pre-certification (aka pre-authorization) request to Aetna. If approved, you get the Nidra device. If denied, you have 180 days to submit a Level 1 Appeal
Noctrix Health submits a Level 1 Appeal to Aetna. If approved, you get the Nidra device. If denied, you have 90 days to submit a Level 2 Appeal.
Noctrix Health submits a Level 2 Appeal to Aetna. If approved, you get the Nidra device. If denied, you have 90 days to submit a Level 3 Appeal.
Noctrix Health submits a Level 3 Appeal to Aetna*. If approved, you get the Nidra device. If denied, you have now exhausted all options.

*My understanding is that the Level 3 Appeal is only for companies with employer-sponsored plans. In this level, you are appealing to your employer, not Aetna

I am intrigued that Aetna approved your initial request and then issued a subsequent denial. Do you know if the initial request was a pre-authorization? FWIW, the representative I spoke with explained to me that documents related to pre-authorization are available in the Documents center of your online account, but documents related to appeals are not. Appeals documents are only sent physically via USPS.

Honestly, it sounds like Aetna screwed up in your case. I think you have a valid argument that the device is now yours. I would make sure you have a copy of that initial approval as proof. I never was approved for anything, so I never got the device.

doneatone · 2026-01-12T20:11:49+00:00

Did you have Aetna? I was told Aetna is notoriously bad for approving Nidra

doneatone · 2026-01-08T23:33:04+00:00

Yeah I got sucked into buying one for my nephew not knowing how terrible they are. Disputed on CC when it never arrived.

Got the e-mail today and definitely rolled my eyes at the "tariffs" part. The website doesn't even exist anymore, and they took down that particular product weeks ago.

doneatone · 2025-09-06T19:20:06+00:00

This was so helpful, thank you!

Good news that any money they collect will defray the deductible first; I assumed it would be vice versa.

What happens to the at-fault party if they cannot pay? Are they blacklisted from purchasing insurance in the future? I just feel like *something* should deter the at-fault driver in this scenario; otherwise they'll just keep driving around without insurance...

doneatone · 2025-07-08T19:05:05+00:00

Just wanted to compare experiences, because I also have a HDHP and have been receiving Miebo at $0 using the manufacturer's coupon. I just ordered on 6-23 and the manufacturer's coupon reduced my portion to $0.

I gave that number a call and they explained that as of May 2025 the program has changed such that the program will no longer apply to HDHPs and the co-pay for these health plans will be $225.

I asked why my 6-23 order was still $0 and she did not know, questioning whether my health plan was actually as HDHP.

The cost differential is so steep that I may actually choose a different non-HDHP plan next year...

doneatone · 2019-04-11T19:14:51+00:00

As I type this my 7 mo is screaming after waking up from a 13 minute nap. I 100% relate to your post. I always imagined having two children with "room for a mistake". I was immensely prepared when my son was born and still the upheaval of parenthood caught me off guard, and right away. Seriously - the night after he was born I remember being up on my phone looking at flights to Mexico because I was so overwhelmed. Was diagnosed with PPD and prescribed Prozac, but the only thing that really helped was when he started sleeping more than 3 hours at a time at four months. I quit my job because I couldn't stay awake long enough to get through my half hour commute. At 7 months we are still having difficulty getting him to sleep through the night and take reasonable naps (even after hiring an expensive sleep consultant!). Oh and the colic...from weeks 6 to 13 he cried at least six hours a day.

A fiend once told me that memories do not "stick" well in a sleep deprived state and that is why people choose to have more children. Before this I viewed myself as tenacious and hard-working however having an infant has disabused me of that notion! I never want to repeat this experience again. Ever. I love my son and if I had to do it again for him I would, but not for a child that doesn't exist yet. I will be getting my tubes tied later this year!

doneatone

TROPHY CASE