posted
Still praying for you Sammy.
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sammy
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posted
Dear friends, thank you, thank you, thank you for continuing to lift me up in prayer.
Your kind words of encouragement and prayers are what's helping me get through these rough days.
I've hesitated to post until now because I felt like I didn't have the words and information to share.
On friday my infusiom co told me that my IVIG was denied. I tried calling the doctor's office but it was too late in the day, no one was able to help me.
Monday I spent 2 hrs on the phone with Cigna. I found out that my most recent appeal had not been denied yet ... BUT ... they were unable to find the letter and the information that my doctor submitted.
I called my doctor's office to tell them what I learned but the nurse was not concerned. She had the attitude that they sent the appeal so their job was done, now all we have to do is wait. But I can't just wait.
Today I tried calling the office manager and ended up leaving a voicemail.
I was feeling upset that here I am suffering, so sick and no one is really helping fight to get me the treatment that I so desperately need.
I tried contacting the Attourney General's office for help, they told me that they do not get involved in personal health insurance problems. They told me to call the Ohio dept of Ins and gave me their phone number.
ODI had me fill out a complaint form explaining what was going on and what I needed their help with. The person I spoke with on the phone was very nice. She said that someone will be assigned to my case, they will look into it and call me tomorrow.
Later in the afternoon I got a call from the doctor's office. The office manager spent over an hour on the phone with Cigna today. She got them to locate the appeal letter and records.
They were supposed to expediite my appeal so (since they lost it for awhile) they will review it within 24-48hrs.
So if you will, please keep praying for me and for those reviewing my appeal. That they will make the best decision for my health. That they will approve my IVIG treatments again.
Thanks so much, sammy
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Dekrator48
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posted
Dear sammy,
It was good to hear from you.
I am continuing to pray for you and the people reviewing your appeal.
Jesus, I trust in You!
Jeremiah 29:1(NIV)
11 For I know the plans I have for you,'' declares the Lord, ``plans to prosper you and not to harm you, plans to give you hope and a future.
Romans 15:13(NIV)
13 May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit.
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
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Sammi
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posted
sammy, thank you for the update.
It is a crime what you are going through to get your infusions. I am glad you contacted your doctor's office manager since the nurse would not help. Also, if you would not have called a lot more time would have passed with nothing being done!
It is good that the office manager and the person from ODI are working on this. You are in the home-stretch finally!
I continue to pray that this will be approved ASAP.
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lax mom
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momindeep
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posted
Good to hear from you! It will work out for sure. The Lord is on this for you and I will be too.
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sammy
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posted
Please keep praying, no news yet!!!
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momindeep
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posted
Praying for you!
Posts: 1512 | From Glenwood City WI | Registered: Jul 2005
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posted
Praying that God will save you! I just know He will!!
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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Dekrator48
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posted
Still praying for you, sammy!!
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
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Sammi
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posted
I am still praying also!
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momindeep
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posted
Aww sammy I AM STILL PRAYING FOR YOU. I remain hopeful that the Lord is doing His work for you behind the scenes.
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poppy
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posted
Insurance companies routinely "lose" paperwork to avoid paying for a treatment. Certified or registered mail probably best in this situation.
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momindeep
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posted
Another new day with the Lord's provision and providence for you sammy. Assurance that He is faithful to you and loves you beyond our comprehension. Praying for you and asking Him to hold on to you. He will not forsake you.
Posts: 1512 | From Glenwood City WI | Registered: Jul 2005
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Dekrator48
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Amen to everything momindeep said!
Praying for you, sammy!!!
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
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sammy
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posted
Dear friends,
Thank you for sticking with me and praying for me every day. Your encouragement helped so much.
I have sad news to share. I just found out that my insurance co denied my 3rd appeal for the IVIG. My doctor's office had to call to get the decision because neither of us have received a letter yet.
They are half hoping that they letter will say that my IVIG treatments are approved.
They told me I have one more chance, an external review. The office doesn't know how to go through and request this process so the manager is looking into it now.
As you can imagine, I am extremely saddened by all this.
I've gotten so weak and sick being off of the treatment. It is scary to have to face many more weeks to months for another appeal. I'm honestly scared that my body won't make it.
I was supposed to have surgery (spine fusion) in April to fix the problems caused by all the compression fractures in my back. (Now I cannot)
I just learned that my DEXA scan was worse this year than it was last year. It is so severe that I cannot have the surgery. My top doctor has never seen anything like this... (T score -5.1 in the spine!).
I keep trying but honestly I feel like I'm losing the battle.
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sammy
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posted
Also, the Attorney General's office and the Ohio Dept of Ins told me that they cannot help. Can't remember if I told you about them.
My heart is broken right now.
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lax mom
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posted
sammy: please, please appeal with Medicare.
Sammi
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posted
sammy, I am so sorry. I am shocked when your test results show that the infusions are warranted.
Please follow lax mom's suggestion. Also contact the CEO of the insurance company telling him/her that IVIG is deemed medically necessary by your doctor, and end the letter with "Can you help?"
I know it is exhausting dealing with all of this. Is there any way you can go back on the insurance you were on?
I am very sorry about your back surgery being cancelled also. You have been through more than anyone should have to endure.
Big prayers continue for you.
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poppy
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Has anyone done this? If so, please post your experience to help Sammy.
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momindeep
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posted
This is very difficult for you. I won't ask why of the Lord...His answers are not understood often...if He were to even say. But I do know, that while you are being dragged through the mud of this world, He is there with you.
And while you are taking it one minute at a time, I will continue to lay your needs at His feet.o
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posted
oh Sammy, I'm so sorry.
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Dekrator48
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posted
sammy,
I am so sorry to hear this news.
I will never stop praying for you.
Have you been provided with any information that tells you what criteria you must meet for your treatment to be approved?
...And upon what grounds they have based the denial on? (Perhaps this is in the letter, but I doubt it. It may just say that the treatment was denied)
It makes no sense.
I would want to know very specifically what labs, etc did not meet the criteria and caused the decision to deny you treatment.
We know that insurance companies base their decisions on money, and do not have your best interest in mind.
Praying, praying, praying!!!
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
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lax mom
Frequent Contributor (1K+ posts)
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posted
With Medicare, was it a Prescription plan denial (Part D) or a Medical denial (Parts A or B)?
susank
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posted
Sammy - I felt certain you would be approved this week.
IIRC you and I have the same insurance company.
The only difference I see is that I was insured with them when diagnosed.
I don't know where the approvals are made/denied. Locally? Nationally?
My card says send claim forms to Chat. Tenn.
Surely criteria is not different according to regions of the country.
Nor should it be based on the type of plan you have with the company like HMO, PPO etc - should it?
Your GAM levels off IVIG are much like mine - except your IGA levels are lower than mine.
How could the same company approve IVIG for me but deny you?
It would be interesting to have an open look at their "files". There should be no "pick and choose" as to whom to cover and not.
This is the same insurance company that is covering your other medical conditions/meds/surgeries? I assume so.
"Just" not the IVIG.
I also do not understand why Baxter is not helping you in the meantime. What - one has to be pennyless to be accepted in their Gardian program?
If anyone needs IVIG you do.
Do you have a Congressman to contact? One that might not have previously known much about IVIG - but might now know of its importance due the bill that Obama recently signed - Re: IVIG and Medicare.
Still praying for you. Susan
-------------------- Pos.Bb culture 2012 Labcorp - no bands ever Igenex - Neg. 4 times With overall bands: IGM 18,28,41,66 IND: 23-25,34,39 IGG 41,58 IND: 39 Bart H IGG 40 Posts: 1613 | From Texas | Registered: Aug 2009
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poppy
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posted
I just remembered that you are probably in a situation with the insurance co as primary and medicare as secondary. That means appealing to medicare is not going to work, I guess.
susank
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posted
Could someone check and see if Ohio Congressmen voted "aye" on the bill? If yes, get names and contact numbers? I am having computer problems otherwise I would do the research.
-------------------- Pos.Bb culture 2012 Labcorp - no bands ever Igenex - Neg. 4 times With overall bands: IGM 18,28,41,66 IND: 23-25,34,39 IGG 41,58 IND: 39 Bart H IGG 40 Posts: 1613 | From Texas | Registered: Aug 2009
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lax mom
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P.Tiberi - R - District 12 M. Fudge - D - District 11
-------------------- Pos.Bb culture 2012 Labcorp - no bands ever Igenex - Neg. 4 times With overall bands: IGM 18,28,41,66 IND: 23-25,34,39 IGG 41,58 IND: 39 Bart H IGG 40 Posts: 1613 | From Texas | Registered: Aug 2009
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Rumigirl
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posted
Please, please, sammy, do see about appealing Medicare. You can't give up, no matter how horrible and discouraging this is.
Before you do the external appeal, which you/your dr should DEFINITELY do, write to your insurance company and ask for ALL of the information that was used to come to a denial, including all internal communications. I will look up the wording to use and email it to you. I originally got it from CALDA. I used it and they sent a lot of very revealing information.
That way, you'll have a better idea of how to target the external appeal. The beauty of the external appeal is that it is done by a neutral medical professional outside of your insurance company.
One other thing you should look into is having a lawyer write a letter for you, threatening a law suit from your precipitous decline, due to their repeated denials. Believe me, this can scare the pants off the insurance co, which is what you need! It could be a legal aid lawyer, if need be. Or if you have a friend or relative who is a lawyer.
I know that you are in no shape to do all this, but someone has to do it. Can you get help from your sister? Or a friend? Even a little? Or an agency of some sort, such as a county agency or a state agency that helps people with problems such as this.
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nonna05
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posted
Sammy, I'm so sorry you have to be pulled down like this.
Has any eating issues gotten better during this time?
Isn't there supposed to be a patient advocate for these problems?
I know a woman who used to be a nurse and just retired from such a position,
She would get in the middle of it all and boy could she put the pressure on.
She had medical and litigation/insurance back ground.. She would fight for patients rights, treatment,etc.
If you went to the ER wouldn't they have to get you sarted ,just to keep you going,,,
Praying for you....Think of you often,
Lord ..Bless Sammy with your favor, break down the walls that are in the way of her geting what she needs to get better,,,,and she'll shout it from the roof tops.
Dekrator48
Frequent Contributor (5K+ posts)
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posted
Still praying, sammy!
Love and hugs to you!!
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
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sammy
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Member # 13952
posted
I've been so sick, I've read your responses but haven't been able to sit up here long enough to reply.
First of all I want to thank you all so much with my whole heart. I'm so grateful for your prayers, encouragement, caring thoughts, and advice.
I do have Medicare parts A, B, D. So far, Medicare has denied our requests for IVIG because they follow suite with the decisions of the primary ins provider. And my primary Cigna continues to deny my appeals with no reason given....
Sad thing is I also have Medicaid right now (as 3rd provider). All this insurance and none of it helps!
Walgreens is trying again to get Medicare and Medicaid to try to cover my treatments together since it looks like Cigna is not going to provide the care that I need. I should hear from them sometime today.
I've also checked into the Baxter/Gammagard program again to see if they could help. They told me that I do not qualify simply because I do have insurance. They will only provide help in the case of a lapse in ins. Mine is a denial but I still have ins coverage.
I've also contacted the IDF (Immune deficiency foundation) advocate to get some help. She gave me some questions to ask the ins co yesterday and wants me to send her info to look over so that she can try to help.
Unfortunately, I could not get what she asked for. I could not get copies of denial letters. I also found out that there were no reasons stated as to why my appeals were denied.
They also cannot find my March appeal. The last appeal that they can find is from Feb.!
I spent about 3hrs on the phone with them yesterday. It's so frustrating trying to get good information from them. I wonder if I called today if I would get different info, if they could find the March appeal? They are that bad.
Please pray because my dad is asking his employer to step in and go above Cigna's decision to have them to approve my IVIG treatment. I hesitate to do this because I fear for my dad's job, I didn't want to bring attention to our medical costs.
But since things have gotten so out of control my dad is insisting that we give them all the information about how Cigna has handled (mishandled) our case.
You are right, we have discussed that we may eventually need a lawyer for the external review. But we have to find out for sure what doctor needs to do the appeal now?!
Thank you so much for your prayers. They are greatly needed and appreciated. I've never felt so bad. I need God to carry me through each day to keep me here.
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lax mom
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posted
I am soooo sorry sammy that you have to go through this insurance mess.
Heck, I would still appeal and appeal and appeal Medicare and Medicaid, in writing because they are bound to reconsider. It never hurts to try.
At one point when I kept getting different answers from the pharmacy and the insurance co (the were both passing the buck), I actually put both of them on a conference call with me...and their stories changed.
I have a feeling that once a lawyer or your dad employer gets involved, things will move quicker.
Don't worry about your dad's employer knowing about this cost. You cannot be the only person on this employer's plan who is sick.
We are all pulling for you sammy and if we could, I'm sure we would try to do the fighting for you
momindeep
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posted
Sammy, I take you to the Best Place every day. I had to get a lawyer to help me fight our insurance for our daughter a few years back. All the appeals and whatnot did not put a ding in the situation UNTIL I got a lawyer and then bam! Made me angry that it took a lawyer, but it was necessary.
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momindeep
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BTW tell your dad I will be praying for him. I know how it is to have a beloved daughter who is very ill and have every effort for her well being trampled.
Posts: 1512 | From Glenwood City WI | Registered: Jul 2005
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Sammi
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posted
sammy have you seen this:
Cigna Medical Coverage Policy, Subject Immune Globulin Intravenous (Human) (IVIG)
I am not an insurance guru, but frrom what I see here it looks like you qualify.
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susank
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Sammy - also - could you contact one of the Reps. mentioned above that could possibly intervene on your behalf with Cigna? They can do these kinds of things I think.
-------------------- Pos.Bb culture 2012 Labcorp - no bands ever Igenex - Neg. 4 times With overall bands: IGM 18,28,41,66 IND: 23-25,34,39 IGG 41,58 IND: 39 Bart H IGG 40 Posts: 1613 | From Texas | Registered: Aug 2009
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momindeep
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Praying that you can rest your mind for awhile on the cross today. That you are able to call to mind His redeeming work just for you and that you can rest assured you are the apple of His eye.
Posts: 1512 | From Glenwood City WI | Registered: Jul 2005
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Dekrator48
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posted
sammy, I am praying for you and your Dad.
Anything is possible with God. Never give up hope.
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
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BTW tell your dad I will be praying for him. I know how it is to have a beloved daughter who is very ill and have every effort for her well being trampled.
- I think about your parents often, sammy. I know they must hurt terribly.
I heard a minister today say that sometimes when we pray we receive His grace, His hope, and His strength and He says, "I love you, my child."
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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momindeep
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posted
Praying that through this time of waiting that you are able to lean on the Lord. That you can trust the Potter and know He is using this trial for His glory. That He will sustain you supernaturally.
Asking others to pray with me in corporate prayer so we all can pray together for you.
Posts: 1512 | From Glenwood City WI | Registered: Jul 2005
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Sammi
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Still praying sammy.
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Dekrator48
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Praying for you, sammy and trusting God to take care of you in every way.
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
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momindeep
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Still praying daily for you ąnd your family.
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susank
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posted
Also still praying. How are you?
-------------------- Pos.Bb culture 2012 Labcorp - no bands ever Igenex - Neg. 4 times With overall bands: IGM 18,28,41,66 IND: 23-25,34,39 IGG 41,58 IND: 39 Bart H IGG 40 Posts: 1613 | From Texas | Registered: Aug 2009
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Dekrator48
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posted
Praying, sammy!!
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
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