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Some Medicare plans don't cover pre-transplant treatments for diabetics


UNDATED (WSAU)  Diabetics are caught in the middle, as regional Medicare contractors are split on whether to cover a treatment that could give kidney transplants to more patients. Wisconsin does not cover the treatments.

But one of the state’s largest health insurers, W-P-S of Madison, is directly involved in the issue. 51-year-old Susan McInerney of Michigan has been on dialysis for six years – and she could not get a kidney transplant because her anti-body levels are too high. For almost a year, McInerney was given a treatment to reduce those anti-bodies, thus making her a better candidate for a transplant. Medicare covered her treatments until last summer, when Michigan changed Medicare contractors. The new one, W-P-S, said the treatments were experimental and should not be covered by Medicare.

McInerney told the Milwaukee Journal Sentinel that it cut off her “saving grace.” The treatments involve higher doses of intravenous immuno-globulin. Some doctors have questioned their effectiveness, and several transplant centers have stopped providing them. But doctors in Michigan and Indiana who were giving the treatments have asked W-P-S to reconsider, and cover them. Tim Taber of Indiana University says it saves lives.

W-P-S says it cannot comment due to the challenge.