Insurance problems - Scared and need to cry and rant!

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PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/3/2009 3:51 PM (GMT -7)   
Hello, Family,
Most of you know I've been having problems financially, health, unemployment, etc, etc, etc.

After much back and forth, and my cousin helping, I finally managed to get a minimal health insurance plan that my cousin could afford to pay the premium on. I wasn't eligible for Medicaid (long story, but it probably would be the same situation I'm about to describe). When I was calling about this policy I specifically asked if they would cover surveyllance endoscopies for my Barrett's esophagus and precancerous condition, and they said yes, at 100%. There's only 4 doctor visits a year covered, and no Rx coverage, but the precancerous stuff was my #1 worry (obviously). This was also a conversion policy from my old BC/BS policy so although it took a lot of wrangling around, there was no pre-existing exclusion on the policy.

Well, I had my visit with my new GI, who I liked and who's from a different hospital. Scheduled the EGD for Dec. 14th. Today I get a message left that I had a $1,000 deductible on this procedure!!!! Was instructed to call my insurance company. So I did (you know what these calls back and forth are like). Was told I had NO deductible, HOWEVER, if the procedure is done in an "ambulatory surgery center" - you know, those places where most of us go these days for same day surgery stuff - that they weren't participating with the insurance so the insurance only pays 70% and I would be billed the other 30%! 30% of these procedures, with anesthesia and biopsies and all is not going to be any small change. So it's not a "deductible'. Big deal. Same difference to me. I called BOTH local hospitals and their outpatient surgery centers are just that - ambulatory surgery centers, and yes, I'd be responsible for 30% of the cost.

So now I have to try my doctor's office back and see if they could do it in the hospital, which is participating, but I know what the answer will be. No. But I'll ask. I understand they need to pay their costs, truly, I do. And that this is the way hospitals are likely going to keep getting around their contracts as "participating providers" in the future, but I don't have that kind of money to pay!

Interestingly, the HALO procedure IS done in the hospital, so I may ask if my insurance would cover that and just have the HALO done now. But you know, I SHOULDN'T have to base moving prematurely into the HALO on cost! And that's exactly why I'd be doing it.

Truthfully, I'm more scared than angry. This is only the beginning of it for me. Even if I got Medicaid, the same thing will be true - even worse, as specialists don't even take that at all.

I'm not asking for fancy, unnecessary stuff. Just to stay alive. Is that too much to ask?

And, BTW, this just a few days before my birthday. Yea, happy birthday to me. NOT.

As a somewhat separate issue, as I've mentioned in a previous post I've been closing down my business, and this post isn't about that, but I was at the office until mid-morning, and have boxes stacked all around me. Had to move it in small boxes, but boy do I hurt today. Can hardly turn my neck. I was shopping at WalMart at 3am, and had been drinking coffee, so of course was awake once I got home until around 6am! And then I slept half the day away only to awaken to have to deal with this insurance business. I just wanted A DAY OFF!!!!!! A day to grieve my business closing. A day to REST MY BODY. And now this.

Sorry this went on so long, but I had to come somewhere I knew people would 'get it'. And I know you do.

Thanks for listening!

PaLady cry

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 12/3/2009 4:06 PM (GMT -7)   
Hey PALady,
so very sorry you had to go thru that, that was horrible to say the least..but at least you found out and hopefully
get scheduled properly...will keep my fingers crossed for you on that...
and hey, Happy early Birthday..Happy happy big day I hope it's special for you and with low pain levels...
Lots and lots of soft hugz

(Insurance is good to have, but you got to jump thru their hoops unfortunatly...I have a total of 1 and only 1 anesthesologist
on my plan and guess what it's not the one at the pain managemnet clinic, so when ever I get a procedure done, it costs a lot,
so this next one is going to eat up my Christmas present money then some, so I guess if it helps that'll be my Christmas present....sad
to says)
Hey what type of cookies do you like, I'm going to making up a batch of iced sugar cookies and maybe some peanut butter..
I'll have to get with you so I can send ya some for Christmas...my present to you some cookies...Hope you like them...
**********************************************
* Asthma, Allergies, Osteoarthritis, Spinal Stenosis, Degenative Disc (Lower Lumbar S1-L3 and Cervical C5,C6, C8 and T1), Fibromyalgia, Gerd,
Enlarged Pituitary Gland, Sjogren's, Ocular Migraines, mild carpel tunnel, ect.... "Would be nice if we could use the edit button in real life"...

********>^..^<********>^..^<********>^..^<********


bsjaguar
Veteran Member


Date Joined Jun 2009
Total Posts : 974
   Posted 12/3/2009 4:12 PM (GMT -7)   
PaLady try to relax now, maybe your doctor will take your case into consideration and do the procedure in the hospital so you don't have the co-pay. I'll keep my fingers crossed for you. Could the doctor some how do the scope in his office environment?

4 visits per year, that's all. So does your follow-up visits after your procedure count as a visit or if you have to have surgery, which I take it the HALO is, will that be another visit or does it count as 1 visit if you are still taking care of the same issue. Sorry for the questions, you have enough on your mind now.

So sorry for all the frustration you've been going through. Just wish I could jump through this screen, give you a hug & tell you it will be ok. My thoughts are with you.
---Jag---
 
DDD, osteoarthritis, fusion surgeries C-5/7 & L-4/5 both in 2006, torn meniscus left knee 2000 & 2002, buldging disc L-2/3


merrygirl
Veteran Member


Date Joined Jun 2007
Total Posts : 702
   Posted 12/3/2009 4:14 PM (GMT -7)   
I am so sorry. I am not too smart when it comes to insurance, so I have no advice, but wanted you to know that I am praying for you and hoping that this gets straightened out asap!


hugs,
and happy birthday!

melissa
Chronic Lyme Disease
Fibromyalgia
Chronic fatigue syndrome
Polycystic Ovarian Syndrome
Sleep Apnea
Hypothyroidism
Adrenal Fatigue
 


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/3/2009 4:33 PM (GMT -7)   
Char- Thanks so much for the cookie offer, but we'll have to make them virtual cookies! Unfortunately, the Barrett's and GERD mean a low fat diet! But virtual ones - no peanut butter, please! - are fine!

Jag - The HALO is a relatively new version of what we all know as Radiofrequency for nerves, but this time done to zap precancerous cells in the esophagus. It's relatively new and I had hoped to have a second endoscopy and biopsy first, to confirm the intial diagnosis, before going for the HALO (which I don't know if the insurance will cover anyway, since it is so new) but I will call and see to at least find out if my insurance will cover it. That is done in the hospital. It's still outpatient basis, but I suspect the equipment is at the hospital. No, none of these are done in doctor's offices - an endoscopy is like a colonoscopy, just down the throat instead!

Melissa - thanks so much for the well wishes.

All of you - thank you so much!

PaLady

Chutz
Veteran Member


Date Joined Jan 2005
Total Posts : 9090
   Posted 12/3/2009 4:37 PM (GMT -7)   
Sweet PaLady,

There is no thing I can do but remind you that I do love you and care what happens to you. You know my email address...use it, ok?

Chutz
The three grand essentials of happiness are: something to do, someone to love, and something to hope for. — Alexander Chalmers

(\o/)Co-Moderator Fibromyalgia & Chronic Pain Forums
(/|\)
Fibromyalgia, PTSD, UC, Diabetic on insulin, collapsed disk, arthritis scattered around and a few other delights.


Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 12/3/2009 7:04 PM (GMT -7)   
 
   Dear PaLady,
  
     I am very sorry you have such heavy burdons to bear right now. I know how unreasonable BCBS can be.... I dislike having to drive past their "new office building" on my way to the specialists in albuquerque. I become filled with anger each time. 7 to 8 floors and a city block of shiny tinted windows and extensive art work. I paid for the fancy new building. Paid for it with my very life.  cry  I dont even care to go into their latest round of antics. All I can say is I am sorry. I am ever so sorry you have to deal with them during a time in your life when you need proper health care.... A chance to decide your own future, on your own terms. There isnt anything I can do other than listen. I am so very sorry they are doing this to you.
 
*huggs*
  dani 

 

 

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood

 

 


Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 12/3/2009 7:20 PM (GMT -7)   
Good Evening my Lady....I just stepped into the office...and thought I would check in with everyone. Of all people I hate to see going through a tuff time....it is you! You are such a special person....and smart as a whip. I can tell you it hurts uis all to see this happen to you.....but let's hope your Dr will have some sense about himself and help you out here. I just don't know how to help you...and we all want to. I always say tomorrow is a new day....lets hope it brings something better for you.

Michael

BigLucy
Regular Member


Date Joined Mar 2007
Total Posts : 413
   Posted 12/3/2009 10:16 PM (GMT -7)   
Boy, do I hear you. Just wanted to let you know that I'm sympathetic. You know what I do and let me tell you it's really bad for people without insurance. I keep working FT b/c I'm really scared to be w/o insurance and it's really hard--I keep thinking that some day I will just pass out at work from the fatigue. I really feel bad for people who want to work and can't but then can't get any assistance. I'm not sure anything, as far as health care, is going to get better any time soon--I can feel the collective anxiety.

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1228
   Posted 12/3/2009 10:38 PM (GMT -7)   
Hi PALady,
I'm so sorry that you have had such an absolutely horrid day. I hope that your doctor can make the arrangements through the hospital for this so that you can avoid the copay. Talk to him, not his booking secretary or any of those other office staff people. He can make or tell his booking secretary to make the arrangements via inpatient admit instead of the outpatient ambulatory. If the insurance company keeps giving you a run around, he will have a good reason, to monitor your explosive blood pressure from all of the aggravation. It is too bad that you can't sue these stupid companies when they have such hidden information or clauses that allows them to pay less than the policy would otherwise. It makes me mad.
I'm also sorry that you had your time to recuperate and recover from the moving and closing of the office. I'm sorry that you are hurting. You are someone who shouldn't be.........
Hugs, hugs and more hugs,
Sandi
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.
Avascular necrosis of left wrist- maybe hips too


White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3611
   Posted 12/3/2009 10:51 PM (GMT -7)   
PALady
Please tell me what can I do to help you with this situation?

My heart goes out to you!

White Beard

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/3/2009 10:56 PM (GMT -7)   
I wish I had it in me to reply to each of you, but my brain and body are both fried tonight. But to Chutzie (very special lady, indeed!), Dani, ScreamingEagle, BigLucy and Sandi my heartfelt thanks for caring. I say this everytime I hit a low spot, but it's true - I don't know what I'd do without this site, and all of your here to come to for solace. I'd never have made it this far.

Sandi you can't get directly to this doctor. It's a group practice, and a hospital-affiliated organization. I have to first find out if I can have the procedure done in the hospital (inpatient would not be necessary or approved, but inside the hospital proper, and billed by the hospital rather than their surgery center would work). If they do any of them over at the hospital, it's ok if I have to wait to get scheduled.

I'm just tired and my body is really hurting tonight. That burning pain (nerve, of course) down my right leg and in my lower back. Haven't had this in awhile but this is my own doing - like everyone else here who overdoes it from time to time.

A HUGE hug back to each one of you!

PaLady

opnwhl4
Forum Moderator


Date Joined Dec 2008
Total Posts : 4961
   Posted 12/3/2009 10:57 PM (GMT -7)   
PaLady-
Sorry to hear this. I was so hopeful you had really found a good policy to take care of the Barretts stuff. I'm praying the doctor will do this at the hospital instead.

Take care,
Bill

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/3/2009 10:58 PM (GMT -7)   
White Beard,
We must have been posting at the same time. Just keep caring and listening, which means just keep being you!

PaLady

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/3/2009 11:00 PM (GMT -7)   
Bill,
Thanks!!! I'm hoping that's true, too. But as long as I'm going through this dance with the hospital and insurance company I'm going to see if the HALO would be covered. Maybe I'd just get it done and overwith.

Cross you fingers for some good news!

PaLady

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 12/3/2009 11:36 PM (GMT -7)   
PaLady...

I'm sorry for the day you've had..... and just the frustration over things. I can relate to that, and know all of the emotions that come with that...
I, too, am thankful for the support of people here and having somewhere that people do understand all that we face w/ the health issues that we have.

I will keep you in prayers, for sure... --Tina
Pain Issues: Neck/back pain; migraines; carpal tunnel syndrome; widespread joint/muscle pain, nerve pain in hands, arms, feet; I also have POTS/dysautonomia; CFS/Fibromyalgia; Severe Hypertension; Hypothyroidism; Addison's Disease; Central Sleep Apnea; etc etc

Meds: MS Contin (480mg daily); Dilaudid (8mg/3x day); Actiq (1200 mcgs/1x per day); Soma (3x day); Atenolol; Midodrine; Phenergan; Effexor and on the list goes...

Future Plans: Intrathecal Pain Pump; already completed trial; awaiting my decision for implantation


golitho
Veteran Member


Date Joined Sep 2008
Total Posts : 1670
   Posted 12/4/2009 12:09 AM (GMT -7)   
I really hope you have a Happy Birthday despite all your worries and problems and stresses and sore muscles. I too wish I could help. I find it so destressing to hear of your plight with insurance. It just doesn't seem right that you have to pay anything, overhere you'd have a health care card and medicare would cover all expenses or 90%.

I can only send my best wishes, my heartfelt hugs and save you from my singing rendition of Happy Birthday.
best regards, golitho

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13473
   Posted 12/4/2009 12:36 PM (GMT -7)   
PaLady I hope some of the dust has started to settle for you. When it rains it pours for us. It seems to be a never ending circle of BS. Sometimes I feel like a rat caught in the maze looking for the exit.
 
Medicare kicked in sooner on me than we thought, therefore everything for a year is rebilled thru Medicare and let me tell you, I am seeing big, big problems already. Even with BCBS as the secondary they only honor Medicare's approved fee's. I am being hit with thousands of dollars in hospital bills for procedures, Remicade infusions that were $11,000 each and I had ten of those. This does not include dr visits, outpatient testing or labs. My average medical bills a year exceed over $300,000.00 a year. Now, I am getting hit with this thinking, what do we do sell the house to to get these people paid before they start hounding us to death. This hit this week. I am physically sick because of this mess. They tell me oh, this is not unusual at all when Medicare and another health ins is involved. Unusual or not this may destroy us financially. My PCP was not a Medicare provider.
 
So, the moral of my story, even when you have insurance it is not always good. I truly understand your plight. I am so darn tired of jumping thru hoops to make all of these idiots happy or workable. I just do not know what we are going to do. I can't cry anymore because I have dried up. All I can say, is from what I have seen thus far. Medicare is a joke. I have already experienced discrimination by being a Medicare patient from a drs office. Its disgusting, they act like you  have the plague when you call and say I have Medicare. It is difficult finding a dr willing to take Medicare because they pay so little and they sure leave the patient holding the bag.
 
I hope your dr will be willing to work around this and do the right thing for you. I sure will be thinking about this.
 

crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & psoriasis and psoratic arthritis. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 17 different daily medications. Intrathecal pain pump implanted June 05.


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/4/2009 12:48 PM (GMT -7)   
Tina, Golitho and Susie,
Thank you (and everyone) so much for your caring replies. I guess it's the only comfort I've got right now.

Susie what you're saying is really scary because all of us with disability will eventually be on Medicare, and if we live long enough will be. I know hospitals and other places need to pay their bills. They need to be reimbursed at decent (but not indecent) levels, and the cutbacks that have come over the years have pushed many of them into this junk of creating new entities which aren't participating providers, and thus they can bill us for the difference. I have a call in to my GI's office now asking if the EGD can be done in the hospital but I'm already pretty sure the answer will be no. Otherwise once everyone caught on everyone would want them in the hospital.

I don't know what 30% of the procedure is but I'm pretty darn sure I can't pay it! I can't believe your bills, Susie! Although I am in favor of health care reform, I fear all the compromises that may be made may make things worse in the long run instead of better. And I know, we can't get political. This really isn't meant as a political statement, but one of humaneness. I fear that programs like the insurance I've got will be considered "insurance" regardless of what they DON'T pay for. I don't mind going without any medical care I don't truly need. Heck, I don't WANT more than I need, but to not be able to get medications and procedures that literally are life-saving to not just me but all of us is criminal, IMHO.

Ok, off my soap box.

Thank you all again!

PaLady

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13473
   Posted 12/4/2009 1:02 PM (GMT -7)   
I am right there with you. People should have reasonablee access to medical care. I am not talking I think my throat may be sore type of thing either. I am on the soap box with you. I honestly do not know what we are going to do. I am just sick over this whole darn mess. It is bad enough to be an unhealthy person, but I feel that I am being penalized somehow because I am unhealthy. I am really bitter about this whole thing. Medicare is not for unhealthy people and I am not trying to scare anyone. If I was healthy I would not be on Medicare. Ita a joke in my opinion, I am so disgusted. I know, my medical bills are outrageous every year. What I would give if it were not this way. My poor husband is about to lose it-he just does not deal with this stuff well at all. He looks at me and says what are we going to do, this is nothing but financial ruin for us. He is retired and not in good health at all, battling severe diabetes and a heart problems, he is not well enough to go get a job. I just don't know what we can or will do.
 

crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & psoriasis and psoratic arthritis. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 17 different daily medications. Intrathecal pain pump implanted June 05.


bsjaguar
Veteran Member


Date Joined Jun 2009
Total Posts : 974
   Posted 12/4/2009 2:05 PM (GMT -7)   
We had to enroll for health insurance through my husbands company recently for the upcoming year. Previously the insurance company would pay 85% of testing and hospital stuff, $20 co-pay for pcp & $30 for specialist. This year the better insurance will only pay 80%, $30 for pcp & $40 for specialist. There was a cheaper plan available that will only pay 70% with the same co-pays for doctors. We went with tthe cheaper one cause last year I had two MRI's on back, CT scan on kidneys, two lumps removed from right breast and even with the insurance paying 85% I still owe the hospital big money. We did get the radiology and anestheology bills paid off. With the choice of paying 20 or 30 percent it was gonna bury us deeper in debt no matter which one we chose. I just keep paying the hospital $40 per month and they never say a word and leave us alone. They still treat me too. I just had xrays on my knees & right kidney the other day.

PaLady maybe you could set up a small payment plan with the surgery center ahead of time, just enough to keep them off your back. Most hospitals work with you if you at least pay something regularly.
---Jag---
 
DDD, osteoarthritis, fusion surgeries C-5/7 & L-4/5 both in 2006, torn meniscus left knee 2000 & 2002, buldging disc L-2/3


fatherjohn
Veteran Member


Date Joined Feb 2009
Total Posts : 999
   Posted 12/4/2009 2:44 PM (GMT -7)   
PAlady, my thoughts and prayers are with you. Take the time necessary to rest the body and the mind and then I am certain that if anyone can get the callling done it would be you. As with all of us, when someone in our HW family is hurting we all understand and care. I have not been on here much lately but try every so often to check in. I saw a billboard the other day that said there is no hopless situations, just hopeless thinking. Boy do I wish that were so. When dealing with doctors and insurance, there are times when the situation is hopeless and we have to do our best to weather the undesirable storm. Take care and I hope things look brighter soon.

privey
Regular Member


Date Joined Oct 2009
Total Posts : 453
   Posted 12/4/2009 3:31 PM (GMT -7)   
PA Lady,
This is horrible and you are the brunt of it. An honest person that doesn't take advantage of anyone or anything seems to always get side swipped in this crazy system while it seems the sneaky ones seem to pull it off and continue to do so.

I worked in healthcare for 33 years in a County governed facility. May I ask if you have that situation where you live? If you do you might check with them and see if they have any type of programs. Our plan was called "Charity Care" and it had guidelines for income and if you met those requirements the hospital would write off some if not all of the bill. Our hospital was part of the Hill-Burton Act in the late 60's I believe and the act required that we operate that way. This was just something that popped into my brain when I read your post and all of the responses today. It might be something you could check on. I also know is Kansas they have places that will cover the bill to some extent and you pay back the company with a very small interest rate.


Again, PA Lady I am sorry for your struggles and I do care. Wish I could help you more.

Cathy

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 12/4/2009 4:54 PM (GMT -7)   
Sending you lots & lots of hugs! ((((((((((palady))))))))))))). I wish I had some wonderful words of wisdom, but end of the semester school work has fried my brain. turn Just know that we are here for you! If I could take away all you troubles, I would in a second!

many hugs,
Skeye

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/4/2009 6:29 PM (GMT -7)   
I will write more later, as it's been a long day. I can't believe how many doctor's offices have called and how many calls I have made, although did make some halfway decent progress. Will know more on Monday and for now I don't care as I am tired of it all and want the weekend to rest!

Skeye - it was so good to hear from you. I know you're busy but when you get some time let us know how you're doing.

I'll write more later. But thank you again everyone!!!!

Hugs for you all,

PaLady
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