how do you get Ins Co, lawyers & doctors to listen

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Halfalive
New Member


Date Joined Jan 2011
Total Posts : 18
   Posted 1/24/2011 3:49 PM (GMT -6)   
Hello all , I am new here and have read a few posts, It is sad to see how many of us are going thru the same thing.
I too have been made to feel like I am doctor shopping... One denial after the other and have to find a new Doctor. It has been over a year since I was hit head on while sitting )not moving) at a stop sign, Hit by a teenage girl rushing home for her lunch brake. My aire bags deployed in my face, I had whip lash, concussion, inner ear concussion and the Fusion I already had in my neck (3 levels) have fractured on all 3 levels as well as one of the screws in my neck cracked in half.
I am now addicted to oxycotin and feel as if my life is over. I am only 41 and I am no longer functioning. I have so many side affects, too many to mention. I also have sleep apnea and just recently found out the reason I may be so tired, is that oxy can cause apnea, so in a person who already has it, it can make it worse, slow down your respiration to the point of causing death. I am getting NO help , every time a doc wants to do surgery, Ins turns around and denies me being able to see that doctor. I am at a loss and feel Halfalive!!

Halfalive
New Member


Date Joined Jan 2011
Total Posts : 18
   Posted 1/24/2011 7:22 PM (GMT -6)   
Is there anyone on the forum who has been thru anything similiar to this when fighting a nofault case, and receiving denials and such. Any advice as to how you handles it would help, thank you

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2317
   Posted 1/24/2011 9:28 PM (GMT -6)   
Has your insurer already paid out your policy limit?
If you haven't received any money yet, have your medical expenses exceeded your policy limit?

Halfalive
New Member


Date Joined Jan 2011
Total Posts : 18
   Posted 1/24/2011 9:39 PM (GMT -6)   
So far I have used 14,000 OF MY 150,000 Policy limit and i have been denied almost all medical, more importantly I havebeen denied surgery and I have been told I have 3 fratures in my 3 level fusion and a cracked screw and I have been left like this.
Right now my lawyers is talking with the "other " insure co, to settle so that I can go thru my own ins and have surgery. Rightnow my own Ins wont touch me either, "they" say its nofault who should pay, they wont even pay medds or anything!. Thank you for your reply!

antbuggey
Veteran Member


Date Joined May 2010
Total Posts : 594
   Posted 1/24/2011 9:50 PM (GMT -6)   
I just wanted to take a minute to say hello and welcome to our family! I am very sorry I do not have any advice! Just know that we are here for you!! Take care of you!!

Hugs,
Beckey
Rheumatoid Arthritis, Spinal Stenosis L3/L4, L4/L5 & L5/S1 with Nerve Impingement, Fibromyalgia, TMJ, GERD, Severe Depression, VERY Large Cyst Right Ovary causing mild twisting, Small Cysts Left Ovary & 3 Large Cysts Uterus

Medications - MS-Contin, Plaquenil, Cymbalta, Famotidine and currently Prednisone

Halfalive
New Member


Date Joined Jan 2011
Total Posts : 18
   Posted 1/25/2011 9:04 AM (GMT -6)   
Thank you for you support, It means alot to me!!

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 1/25/2011 9:46 AM (GMT -6)   
I was in a car accident that also was someone else's fault (he crossed the median on the highway and smashed into me). No ambulance was called to the scene though my car was totaled and I was bleeding... I was still able to walk (or more like stumble around). But I did have a friend pick me up and take me to the ER. No fractures, but through an MRI some time later, it turned out that the cartilage in my hip was seriously damaged as well as the ligaments holding my SI joint together.

A few days later, after being in excruciating pain and unable to walk without crutches, I sought out a lawyer.

The lawyer took my case and he (like most accident/workers comp lawyers) have doctors they specifically work with. I didn't even use my insurance and instead the bills were simply delayed until settlement... even an expensive surgery. That strategy, though was scary. Doctors took out liens against my settlement and finally, 3 years after the accident when the liable party's insurance paid out, they were all paid in full.

I switched attorneys through the process as I initially went to someone just down the street. I later found one with a powerful reputation. His approach was a bit different: go through insurance as much as possible. If they accept, great, if not, use his doc and at least you have the filing which can be used in negotiations if necessary later. Insurance companies will want their cut of the settlement later, but they will more likely write off amounts that the doctors connected to the attorney will not.

So, hopefully you have the insurance information for the liable party.... assuming she has insurance and her policy is half-decent in size. Your attorney should know what her liability max's are and he should be able to get all your bills taken care of through that. In my case, the liable party was a truck owned by a regional chain. So their policy was quite large. You need to address this issue of max liability with your attorney. He needs to tell you what her policy states, or at least let you know whether it is as high as your expected bills. If you're not happy with him. You can always find a different attorney. If you switch, the two attorneys will work out between themselves who gets what (assuming this is all on contingency).

Keep in mind that most of what I have said depends upon the size of the liable party's policy. But if it is at least 100K, you should be able to find a good attorney to take your case.

Good luck.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs)
RT hip and SI joint damage from car accident
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .5mg ativan as needed for sleep.

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 1/25/2011 11:52 AM (GMT -6)   
i went through the exact same thing with insurance approval for a lumbar fusion, (my second back surgery) in 2006, in 2008 i got approval. it was a stressful experience to say the least. the way i found that you had to go about it was apply repeatedly and in your state you may have a insurance umbudsman who can advocate for you. as far as bringing a case against your insurance company you can only sue for approval for surgery but you still have to pay for it and pay a high powered attourney a fortune. if your in pain, and i would think with a messed up cervical fusion you are, you need the drugs. i would like to see some of these judgemental hypocrites to try this with no drugs.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16301
   Posted 1/25/2011 1:22 PM (GMT -6)   
Hi Half and welcome to Healing Well's chronic pain forum. I am sorry that you have to be here but glad that you found us. Your story is similar to so many here at the forum. It is very stressful dealing with insurance companies for sure and not feeling good and in pain at the same time is just not good. Depression and chronic pain go hand in hand for many of us. Some of us also experience anxiety as well.

When I was able to work I worked as a paralegal for attys that handled personal injury claims. Something you need to know so that it does not get real confusing and many of our members may not be aware either, is that each state has its own laws that applies to automobile accidents on what you can and cannot do on a claim.

My experience in PI claims is the adverse insurance company never paid money up front for a person to seek medical care whether it was for surgery or any treatment relating to the accident. No money was ever paid up front except for the property damage to the vehicle. Using your specials is how they arrive at a figure on settling the claim. Does your atty have any idea what the policy limits are on the girl that hit you. In Tx where I live the ins co does not have to divulge the amount of the policy limits unless a lawsuit has been filed in district court. But there are way to get an idea what you are dealing with too in this area. When a person needed surgery what we did was get together an estimate on what the person's future medical expenses were going to be including lost wages incurred if this person worked at the time of the accident. If the other driver's policy was not enough to prefect the claim then we filed an Under-Insured Motorist claim on your policy and did the same using your future medical expenses to collect on your policy. Did you have Uninsured/Under-insured Motorist coverage on the vehicle you were driving in this accident? What about Personal Injury Protection coverage? These are two separate coverages that we can buy when insuring our cars, its a separate type of coverage and if you declined such coverage you had to sign a waiver rejecting the coverage.

Since the other driver's insurance company has denied your surgery which is typical has your atty filed suit on your behalf in district court? Once a case goes into a lawsuit thru the court system there is a lot of stuff going on that the client is not actually involved in. A lot of it is whats called discovery and its a paper war between your atty and the atty for the ins co.. It can be a lengthy process too, depending on how backlogged the courts are where you live. There a process that each case has and no step can be left out just to shorten the wait time. It can be so stressful going thru this mess as you already know but just try to hang in there.

Do you have private health insurance? If so, why are you not using your health insurance to get the care that you need? Your private health insurance can subrogate to the other party's insurance to get back any money they have paid out for you medical expenses out of any settlement you receive from that company. This is done all the time no matter what state you live in.

Anyway, I wanted to pop on and tell you welcome aboard. I do hope you can get some of the pain reduced and soon. Take care.
Moderator Chronic Pain Forum

Halfalive
New Member


Date Joined Jan 2011
Total Posts : 18
   Posted 1/25/2011 5:01 PM (GMT -6)   
Want to thank everyone so much for all the advice, Lots of questions for me to answer here and in too much pain to type for any lenghth of time here. But I will say that it was MY Ins co who denied surgery.
My Ins is also dening any bill that comes in they believe should go to no fault and now the Bills are coming to me.
My lawyers has been in negotiation with the other Ins co since Oct 9th, but no word at all on a settlement,.
My lawyers said he will not seek a court date until he hears from the Ins co what they will offer.
Also the girl who hit me has 300,000 policy, my lawyers says that is "good news" But I wonder why- IT has yet to help me in anyway, exept to give a small amt of money for my totalled vehicle that I had just paid off. Now I have a peice of junk I have to keep putting money into.

All of your advice has made me make a list here of things I need to look into and the laws in my state and that I will do. I can not tell you how very much it mean to me that you all are responding and helping me, the support is putting a smile on my face that has not been there in awhile. I will post agin when I am not in so much pain. And will begin looking into everything mentioned here, I will be back to finish answering questions you all have asked. Thank you again

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16301
   Posted 1/25/2011 5:19 PM (GMT -6)   
Half I do know in my state that you collect a settlement from the adverse party's ins company first, then if that policy is not enough you kick over into your own policy under the Under-Insured portion of your policy. Sounds like your state may be the same way.

But, foremost if you have health insurance you should have been using it all along for treatment. Talk to you later and get to feeling better.
Moderator Chronic Pain Forum

Halfalive
New Member


Date Joined Jan 2011
Total Posts : 18
   Posted 1/25/2011 5:23 PM (GMT -6)   
thank you so much, I am making a list of Doctors I need to go see and will Bill thru my Ins and see what happens.
I have hearing loss as well and just recently found out it could be from the oxy. and the pharmcist said that some of my symptoms are related to the fact I have build a tolerance to the oxy and may be withdrawing. So I feel awful and its doing nothing for the pain. Im going to get right on this and take care of my health and forget the bills for now, you have all given me such good advice, I thank you from the bottom of my heart.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16301
   Posted 1/25/2011 5:27 PM (GMT -6)   
Are you saying you have health insurance all along and have not been using it? OMG, that is so wrong to not be using it. Like I said, they all have what is called a subrogation clause which means if the injury is caused by a third party and they pay your medical expenses they have a right to reimbursement by the third party insurance company out of any settlement. Your lawyer should know this!!!!! Do get yourself to feeling better.
Moderator Chronic Pain Forum

Halfalive
New Member


Date Joined Jan 2011
Total Posts : 18
   Posted 1/25/2011 6:08 PM (GMT -6)   
Nice, my lawyer told me the best thing to do is not go to the doctors right now because I may have to pay the Bill, then the Bills start coming in, some go to collection, so I stopped going, thinking I am adding to a problem I cant fix. OMG is right!!!! I need a new lawyer. I just dont want to have to pay them both. Im lost and very upset, but thank you for the advice

damgalnuna
Regular Member


Date Joined Aug 2010
Total Posts : 77
   Posted 1/25/2011 7:30 PM (GMT -6)   
I don't know anything about dealing with insurance companies with respect to motor vehicle accident personal injury claims, but I just wanted to welcome you to the forums. I am so sorry you have had to go through so much financial and bureaucratic stress, while also dealing with the physical injuries caused by the accident. I wish you luck in finding a positive resolution.
Scoliosis fusion w/rods (92); herniated disc (96); partial removal of rods (97); microdiscectomy (97); sudden inc. in pain (08); tried various non-pharm treatments and take the following: baclofen, Nucynta, topomax, tramadol, welbutrin, ativan, ritilin. Considering a fourth surgery extending existing fusion to sacrum.
I design jewelry to distract myself from the pain: http://bit.ly/h3rcGT

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3695
   Posted 1/26/2011 2:01 AM (GMT -6)   
Halfalive
 
I too want to Welcome you to Healing Well Chronic Pain Forum.  I can't be much help to you on anything about your accident, bu it seems like the others here on the forum are giving you some excellent advice.  However I to am on Oxycontin, and I to have sleep apnea, and yes allot of the opiate pain meds can cause central apneas.  Most people have the common obstructive sleep apnea, which is when their throat collapses thus shutting off the air going to the lungs. but central sleep apnea is  when the brain quits telling the lungs to breath.  Many things can cause central apneas, conjestive heart failure, injury to the brain stem and upper spinal cord, numerous neruological conditions, and diseases, and  the use of Opiate pain meds, and ideopathic cause, ( no know cause for it)also in some rare cases,   some of us using CPAP or BiPAP to treat OSA  the CPAP and/or BiPAP  treatment causes us to have  central apneas or like for me it  makes them worse!  Anyway the treatment is pretty much the same as it is for Obstructive Sleep Apnea ( OSA) , except the machine is different. They use the CPAP and BiPAP machine for OSA treatment, and the Adaptive Servo Ventilator ASV machines for treating Central Sleep Apnea (CSA) and Complex Sleep Apnea, which is having both OSA and CSA. I use the ResMed VPAP Adapt SV  along with 3 Liters of supplemental Oxygen when I sleep at night.  Now Have you been diagnosed with Sleep Apnea? Have you had the sleep study done? and are you being treated for it?  If not, you definitely need to get a sleep study done and get into treatment, if you already have had it done, and you are being treated with a CPAP or BiPAP machine and you are still having trouble, then you definitely need to see you sleep Apnea Doctor, and get another sleep study done, to see if you are having central apneas.  If your having pain and the pain meds help you, then don't get off of them because of the sleep apnea. Just go see your sleep apnea doctor, and  get a sleep study done and get on the proper treatment.
 
I do wish you well! and again I want to say Welcome to our CP Family!
 
Good Luck to YOU!
 
White Beard
Moderator Chronic Pain
After spending nearly 22 1/2 years in the USAF, I retired in Sept, 1991. I then went back to school and became a licensed RN in 1994, and I worked on Oncology and then a Med Surg Unit, I became disabled in late 1999 and was approved SSD in early 2002!-- DDD, With herniated Disk at T-12 and L4-5. C5-C6 ACDF in Sep 2009, C6-C7 ACDF in Mar 1985, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications:Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV I am White Beard with a White Beard!

Scarred_for_life
Veteran Member


Date Joined Jul 2008
Total Posts : 1560
   Posted 1/26/2011 6:24 AM (GMT -6)   
Halfalive;

I just wanted to welcome you to HW and say that I am sorry you are in so much pain. I know what it is like dealing with ins. when your hurt in a car accident. I also know what its like to be on the other end of the spectrum as well. Four years ago I rearended a car on the hwy. Now, I have to explain that I have really good car ins.....state farm to be in fact and they paid every last dime of the other driver and passengers claims. One of the passengers was even a veteren and they paid everything on him through the gov.

I was very happy that their injuries did not lead to something really bad, I could not have lived with myself knowing that I caused someone's death. Being on the receiving end of aa intersection crash and having a jury tell you that it was both your fault and the other driver is not exactly an easy pill to swallow. But I think it made me a stronger person.

I had a very good attorney who utilized my ins to the maximum and it was resloved after three years. Though it caused some tension between my ex and I (bills were coming in not paid and stuff) my attorney told me just give him the bills and he would handle them. And they were handled within a few days.

I sure hope you get this resolved soon. I hate seeing someone in so much pain and not being able to do anything about it. My advice is seek out a new attorney and get your tail to a doctor.

Hugss

Scarred
I live to "Tame My Pain!" 

Testosterone
Regular Member


Date Joined Jan 2011
Total Posts : 52
   Posted 1/26/2011 6:59 AM (GMT -6)   
With personal I jury lawyers, you don't have to pay them until the recoup your losses +more. Fire him, find a better attorney. He doesn't have your interests in mind.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16301
   Posted 1/26/2011 12:42 PM (GMT -6)   
Half you can call your health insurance company and talk with them about your medical situation. They will be able to answer your questions on subrogation too. Why did the atty tell you to stop going to the dr?

Ethically, if you have an atty on Contract, another atty is not suppose to speak with you about your case, some will, some will not. And with another atty not knowing your situation totally don't rely on him being any better than what you have now. The reason I say this is, they are all hungry for new cases to walk in the door. So, yes, a lot of time they blow a lot of smoke on what they can do for you, when they can't. I am assuming your current atty was hired on a contingency contract. Also, is you atty board certified in personal injury? That is the type of atty you need working on your behalf.

Have you gone back to your dr about how the pain meds are not working and you are not doing well? If not, I would be getting an appt set up.

Take care and let us know how you are doing.
Moderator Chronic Pain Forum

purplereading
Regular Member


Date Joined Nov 2010
Total Posts : 108
   Posted 1/26/2011 1:03 PM (GMT -6)   
I had an accident where the other party was drunk, and hit me head on in my lane of traffic, after dark with no lights on. It was his fault, but , unfortunately, he only had 100 000 as it was an SR22, or something like that due to all his prior offenses. I had health insurance, car insurance, and my husband's health insurance. I was taken by ambulance to the hospital. Depending on your state's law, you can sometimes be entitled to both, but in others, like mine, the car insurance is primarily responsible. So, the hospital, drs, can choose to accept the payment from the accident, but most know it may be years before they get paid, due to possible litigation, settlements, etc. Initially, my health insurance paid, as didi my husbands', and with over a $100000 overpayment from them, the hospital still filed a claim against the insurance payment from the other driver. This was just the initial expenses, as due to the injuries it has actually been ongoing for years, but his money was long ago exhausted. I had what is called a third party provider as health insurance, which basically means that it was not an actual health insurance plan, but a plan where they rent the providers, etc. In out state, the judge(if Iwent to court) could rule that is was health insurance and had to act like any health insurance, because that is how they list it as benefits. But as a third party provider, they did not want to pay if another party was responsible. IN the end, with no attorney, my health insurance paid and I did get his $100 000, as I got the hospital to release the lien agaisnt the remaining. $30000. The first check I got right after the accident was my car value. Then a few months in, the balance that did not have the lien against it. Then year or more the balance that was the lien. The auto ins. just wanted to settle, as they knew from the injuries and the bills submitted, from the ER, and the first surgery, that the claim would exceed his 100000plan. The hospital was the hold up. I do no believe that the car insurance can stop you from having any treatement of any kind, as they do not have that authority, they only have the reponsibility for the accident, and payment of the bills submitted to them. ( am an RN, who was also the Credit manager for a Clinic, for years.) So I am not sure who is denying your claim. IF prior authorization is not required for your health insurance, then I do not understand why any procedures are being denied. You go to a dr or hospital.who takes your insurance, and seek treatment. After the bills are submitted, the health ins co should send you a letter, asking is there should be any other person, or policy responsibile for the bills. Then you list the other person's insurance, and if you have under or uninsured drivers coverage, yours as a secondary. Yours would then pay onlly if the other persons policy was exceeded. You will not receive any personal payment if the bills exceed the coverage. Then , if the bills exceed the accident coverage, your health insurance will have to come in and pay the bills. You can call the insurance commission of your state for advice. The biggest problem with an attorney, is that they take 30 or 40% of what you receive., as settlement for pain and suffering. IF there is true fault of the accident the company usually cooperates, by just contact from your insurance company and there is no use for the attorney. Perhaps, the biggest problem you have is that you have waited a year. The injuries should have been evident from the day of the accident, and treatment followed. I guess I did not get all the details from your post as to why you were not initially treated for all the injuries you received at the time. That may be the problem with the insurance company not settling, as it is usually done in 90 days, or at least before the end of the year, so as to avoid carrying it forward. More info would help. T

purplereading
Regular Member


Date Joined Nov 2010
Total Posts : 108
   Posted 1/26/2011 1:07 PM (GMT -6)   
Sorry to add to my above post, but why is this a no fault accident, if you were hit from behind by another driver. That is always the rear driver's fault. Please explain more fully.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16301
   Posted 1/26/2011 1:13 PM (GMT -6)   
Its a term used by the states that have no fault coverage. Look at the site Frances posted it gives a better explanation than I can give, lol. A lot of people think if a person is rear ended its an automatic claim against the other person but not entirely true.
Moderator Chronic Pain Forum

Halfalive
New Member


Date Joined Jan 2011
Total Posts : 18
   Posted 1/26/2011 1:19 PM (GMT -6)   
I am so glad I found this forum. I think the problem here is I have been getting no guidence at all with my lawyer and I do not know how these things work. I will be on the phone with him asap, and I am now going to see my pain doctor today!!
And any other doctor I feel I need to see. I can tell some of you are confused with my story and it is because I dont know alot of what you are asking me. None of this makes sense to me. But my lawyer did tell me to try not to go to the doctors because I may end up with the bill in the end. I told him that we need to settle then , because I need help and I am getting worse. He sent me a letter stating he WOULD NOT get me a court date until he heard from the other Ins co adj. as to a settlement. I also asked him if the other parties Ins would pick up and help pay the bills, he said NO. I have gone to my primary doctor and because I spoke with her about my pain and the accident she billed no-fault, and they denied it, I got thebill. I did send that to my lawyer!!. I would like to respond to each and everyone of you, you are all so helpful and I will keep trying to answer all the questions as well as look into what you are all telling me, as I am hearing some of this for the first time and I thank you all so very very much for your support.
Oh also, in the ER the day of the accident they did a MRI and said It looks like possible fractures, he put a collar on my neck and sent me home with pain meds and told me to follow up with my own Doctor! That doctor said the fractures would heal in time, and eventually I went to another doctor as he did not want to see me anymore, He just told me not to come back, I felt like he did not believe me or he wanted nothing to do with no-fault, the next doctor I saw said I had 3 fractres and a cracked screw at C6-7, and needed surgery , that it would not heal on it own!! My next appt with him was to schedule surgery and when I wen tin to see him , he told me that Ins denied all future visits with im, and that he could not see me anymore. He told me "THE health care system is letting you down. and there is nothing I can do about it" at that point my lawyer told me to go dr>>>>>, one he works with, same story- fractures, cracked screw- I need surgery!!! Ins denied the surgery and this is where I am now. I will be back on later and continue to answer these posts, I need to go the my pain doctor now. Thank you All , Have a wonderful afternoon!

Halfalive
New Member


Date Joined Jan 2011
Total Posts : 18
   Posted 1/26/2011 1:26 PM (GMT -6)   
I was hit head on while sitting at a stop sign, my car was not moving, She came around the corner in my lane and hit me head on- airbags deployed, my car was totalled, She was given a ticket for reckless driving. I went to the hospital in Ambulance, I lost conc. at the scene. Next day went back to ER, very sick and dizzy- had catscan- Ithey said it was a concussion.
Mri, bones scan, catscans, x-rays- all show fractures and a cracked screw.
Also had an inner ear concussion, spent a couple months vomiting and dizzy and it extreme pain. I have had doctors want to schedule surgery, Ins denies it. I will be calling my Ins co to expalin this all to them. that is one step Im taking as well as calling my lawyer to ask some questions. Again thank to all!!!

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16301
   Posted 1/26/2011 1:40 PM (GMT -6)   
Half be sure to call your health insurance company today and be sure to explain to them the no fault has denied paying your medial bills. Let them know all the info they ask for.

Let us know what they say.
Moderator Chronic Pain Forum
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