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> .......I get TIRED of having to fight for everything.

********************

Well, that's what they're hoping for. When I finally realized that my

insurance co. was making me sick, I called the State Dept. of Insurance and

let them fight for me.

Now, I know nothing about TriCare, but it is an insurance company, out for

the bucks like the rest of them, I would assume, so is there any way you can

jump through their hoops so you can get to the External Independent Review

Board?

You know, it's not over 'til the fat lady sings! :))

in NJ

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MAN I am really bummed OUT! I found out today that even if I have

medical reasons for having plastic surgery that Tri Care won't pay for

it and that they aren't doing PS at the Army Hospital near me any more.

THIS sooooo pisses me off!!! Others who have had GB and have tricare get

PS......but when I finally decide that I have had enough (they are

putting me on maintance doses of antibiotics now!!!!! One

daily....@*#*($*@#)) Opps sorry. :-)) I can't get it done. It just isn't

fair. THEY willingly let you have GB knowing FULL well that the majority

of us will NEED PS eventually. Even if I document EVERY little pain,

ache, rash, infection.....I was told that I could see my Doc till the

end of time, but that Tricare won't pay for PS. I am so tired of

constant infections.....and antibiotics......and now

this.......sorry.....don't mean to dump, but this has really gotten me

upset. I know others are in the same boat. Funny how it becomes more

important when it is happening to you. I have never had to worry about

what tricare would or wouldn't pay for.....I NEVER ask for anything that

I might NOT need.....have always been the good little girl and tried to

work within the system. Now the system jumps up and bites me in the

butt!!!!!! Heaven knows......I have enough skin on my BUTT for them to

BITE!!!!!!

Debbie in Gig Harbor

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Debbie, I am sooo sorry. I just wonder, and I know this is a

technicality, if they pay for reconstructive surgery. That is actually

what you are needing. Might be worth a try. I also heard someone

mention that they were going to open up a PS account at her bank to start

saving for hers. Maybe that would work. Personally, I could not have

done it without insurance.

Lori Owen - Denton, Texas

CHF 4/14/01 479 lbs.

SRVG 7/16/01 401 lbs.

Current Weight 302 lbs.

Dr. Ritter/Dr. Bryce

On Mon, 6 Jan 2003 13:43:04 -0800 " Debbie McNeice-Schuyler "

ladybostons@...> writes:

> MAN I am really bummed OUT! I found out today that even if I have

> medical reasons for having plastic surgery that Tri Care won't pay

> for

> it and that they aren't doing PS at the Army Hospital near me any

> more.

> THIS sooooo pisses me off!!! Others who have had GB and have tricare

> get

> PS......but when I finally decide that I have had enough (they are

> putting me on maintance doses of antibiotics now!!!!! One

> daily....@*#*($*@#)) Opps sorry. :-)) I can't get it done. It just

> isn't

> fair. THEY willingly let you have GB knowing FULL well that the

> majority

> of us will NEED PS eventually. Even if I document EVERY little

> pain,

> ache, rash, infection.....I was told that I could see my Doc till

> the

> end of time, but that Tricare won't pay for PS. I am so tired of

> constant infections.....and antibiotics......and now

> this.......sorry.....don't mean to dump, but this has really gotten

> me

> upset. I know others are in the same boat. Funny how it becomes

> more

> important when it is happening to you. I have never had to worry

> about

> what tricare would or wouldn't pay for.....I NEVER ask for anything

> that

> I might NOT need.....have always been the good little girl and tried

> to

> work within the system. Now the system jumps up and bites me in the

> butt!!!!!! Heaven knows......I have enough skin on my BUTT for them

> to

> BITE!!!!!!

>

> Debbie in Gig Harbor

>

>

>

>

> Homepage: http://groups.yahoo.com/group/Graduate-OSSG

>

> Unsubscribe: mailto:Graduate-OSSG-unsubscribe

>

>

>

>

>

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Oh Fay, I KNOW that is why they aren't doing PS at the Army Hospital any

more. BUT........they can refer you to a Civilian Doctor who accepts

Tricare. My family practice Doc won't even do that. WELL......I have

NEWS for her.....first off........I am getting myself re-assigned to a

staff member instead of a resident. THEN I am going to pester the hell

out of them with rashes, infections and every little complaint I can

HONESTLY think of (and I do mean HONESTLY) until they yell UNCLE! They

will be so sorry they EVER told me NO! I hate having to PLAY this game,

but you know.........I have been in the military system ALL of my life

(was BORN in a Navy Hospital....and the Navy will probably kill me off!)

so I know how to play their little games. It may take time......and it

could take years......but if I can get this changed I will, because it

is so unfair. I am NOT above writing to my Congress man (I actually

think she is a woman) and pestering.......So we shall see what we shall

see. Once I get over my BOO-HOOING.....I get mad.....you don't want to

make me mad.

Debbie in Gig Harbor (GO AHEAD make MY DAY!!!!!! )

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Reconstructive Surgery........hummmm Interesting idea. Once I get a doc

I think I can work with.....I will put the reconstructive idea to

him/her. I have to say.....even though I am good in a FIGHT.....must be

the Irish in me.......I get TIRED of having to fight for everything.

Debbie in Gig Harbor

ladybostons@...

www.paws2print.com

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Anybody got any suggestions as to how I can go about getting insurance to

pay for a TT, 21 years post op? At the time I had surgery, any plastic or

reconstructive surgery was considered strictly cosmetic, and I was so happy

at having insurance pay for my WLS without a whimper, it never occurred to

me to pursue a TT...I'm not in BAD shape...nothing that control top

pantyhose or tight jeans won't cover up, but we just bought a boat, and I

really don't look forward to spending the summer in a bathing suit, which is

exactly what my hubby has in mind. Not that he's ever complained about how I

look. He thinks I'm gorgeous. But seriously...As for breast reduction, I

unfortunately don't need that...will they pay for implants? I went

from a 44D to a 36B (on a good day), and on most days, I don't wear a bra if

I don't have to, because I've never found one that fits comfortably, and I

get embarrassed continually pulling it down in front...I pass the " pencil

test " so I don't worry about it too much. Wear a sports bra thing most of

the time in the summer and when riding...Now, about that TT...

Jac

mailto:jholdaway@...

http://www.pictureitdigitaldesigns.com/

http://members.cox.net/xxxfarmpaints

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In a message dated 1/6/03 3:44:44 PM Central Standard Time,

ladybostons@... writes:

<< .I was told that I could see my Doc till the end of time, but that Tricare

won't pay for PS. >>

----------------------------

Is it possible for you to change insurers?

Carol A

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Geez, Debbie, I'm glad I'm not your dog!! Just kidding! Thank

goodness we have this forum instead. Who else can understand the

incredible frustration of working so hard only to get stuck in the

mud just when you thought the end was near?

I know you're going to get to where you need to be, but now you have

to sit down and draw up a whole new strategy. Luckily lots of others

here have been through it, so I imagine you'll get tons of help.

I dread having to go through what you are going through now. I hope,

cross my fingers that it goes relatively easy with the insurance

co..

You made a great point though. I've been lolly gagging, but you

never know when the insurance co. will all of a sudden change their

policy and stop coverage. I know other UHC people have been covered,

but I'd better not take it for granted. Thanks for the reminder.

Vicki A.

> Debbie, I am sooo sorry. I just wonder, and I know this is a

> technicality, if they pay for reconstructive surgery. That is

actually

> what you are needing. Might be worth a try. I also heard someone

> mention that they were going to open up a PS account at her bank to

start

> saving for hers. Maybe that would work. Personally, I could not

have

> done it without insurance.

> Lori Owen - Denton, Texas

> CHF 4/14/01 479 lbs.

> SRVG 7/16/01 401 lbs.

> Current Weight 302 lbs.

> Dr. Ritter/Dr. Bryce

>

> On Mon, 6 Jan 2003 13:43:04 -0800 " Debbie McNeice-Schuyler "

> writes:

> > MAN I am really bummed OUT! I found out today that even if I have

> > medical reasons for having plastic surgery that Tri Care won't

pay

> > for

> > it and that they aren't doing PS at the Army Hospital near me any

> > more.

> > THIS sooooo pisses me off!!! Others who have had GB and have

tricare

> > get

> > PS......but when I finally decide that I have had enough (they are

> > putting me on maintance doses of antibiotics now!!!!! One

> > daily....@*#*($*@#)) Opps sorry. :-)) I can't get it done. It

just

> > isn't

> > fair. THEY willingly let you have GB knowing FULL well that the

> > majority

> > of us will NEED PS eventually. Even if I document EVERY little

> > pain,

> > ache, rash, infection.....I was told that I could see my Doc till

> > the

> > end of time, but that Tricare won't pay for PS. I am so tired of

> > constant infections.....and antibiotics......and now

> > this.......sorry.....don't mean to dump, but this has really

gotten

> > me

> > upset. I know others are in the same boat. Funny how it becomes

> > more

> > important when it is happening to you. I have never had to worry

> > about

> > what tricare would or wouldn't pay for.....I NEVER ask for

anything

> > that

> > I might NOT need.....have always been the good little girl and

tried

> > to

> > work within the system. Now the system jumps up and bites me in

the

> > butt!!!!!! Heaven knows......I have enough skin on my BUTT for

them

> > to

> > BITE!!!!!!

> >

> > Debbie in Gig Harbor

> >

> >

> >

> >

> > Homepage: http://groups.yahoo.com/group/Graduate-OSSG

> >

> > Unsubscribe: mailto:Graduate-OSSG-unsubscribe

> >

> >

> >

> >

> >

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Jacque, I don't see why they wouldn't if you can prove medical necessity.

That seems to be the trick in getting TT paid for is proving medical

necessity such as lower back problems, persistant yeast and/or kidney

infections, rashes, etc. May also want to suggest reconstructive

surgery. I think I heard of someone getting it covered by claiming

reconstructive surgery instead of plastic surgery. Just a thought.

Lori Owen - Denton, Texas

CHF 4/14/01 479 lbs.

SRVG 7/16/01 401 lbs.

Current Weight 302 lbs.

Dr. Ritter/Dr. Bryce

On Mon, 6 Jan 2003 16:37:15 -0600 " Jacque Holdaway " jholdaway@...>

writes:

> Anybody got any suggestions as to how I can go about getting

> insurance to

> pay for a TT, 21 years post op? At the time I had surgery, any

> plastic or

> reconstructive surgery was considered strictly cosmetic, and I was

> so happy

> at having insurance pay for my WLS without a whimper, it never

> occurred to

> me to pursue a TT...I'm not in BAD shape...nothing that control top

> pantyhose or tight jeans won't cover up, but we just bought a boat,

> and I

> really don't look forward to spending the summer in a bathing suit,

> which is

> exactly what my hubby has in mind. Not that he's ever complained

> about how I

> look. He thinks I'm gorgeous. But seriously...As for breast

> reduction, I

> unfortunately don't need that...will they pay for implants? I

> went

> from a 44D to a 36B (on a good day), and on most days, I don't wear

> a bra if

> I don't have to, because I've never found one that fits comfortably,

> and I

> get embarrassed continually pulling it down in front...I pass the

> " pencil

> test " so I don't worry about it too much. Wear a sports bra thing

> most of

> the time in the summer and when riding...Now, about that TT...

>

> Jac

> mailto:jholdaway@...

> http://www.pictureitdigitaldesigns.com/

> http://members.cox.net/xxxfarmpaints

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<

>

Debbie, during my request and series of appeals I never referred to my surgery

as plastic surgery, only as reconstructive surgery. Never called it a tummy

tuck, only an abdominoplasty; never a breast lift, only a mastoplexy. And I

steadfastly referred to my plastic surgeon as a reconstructive surgeon. Don't

know whether it made a difference to the insurance company, but it made a

difference in how I felt about it!

Kate

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<

>

Now there's a thought! I've been going to a chiropractor for over a year now

(quit going, and back problems, lower, came back, went back to doctor) and

have had unexplained " itching " for almost 3 years...not UTI, and can't find

the problem.

Jac

mailto:jholdaway@...

http://www.pictureitdigitaldesigns.com/

http://members.cox.net/xxxfarmpaints

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<

>

I have a friend who had her abdominoplasty done 12 years after her gastric

bypass, but I believe it was in conjunction with a hernia repair. She had the

abdominoplasty covered for the same reasons someone only 2 years out would:

problems with mobility, back pain, etc. If you don't have any documented

problems, you are not going to get it covered.

Now on the bright side, an abdominoplasty by itself would only cost around

$6,000. That's the price of a really nice vacation, or 1/4 or a car. Trust me,

it's way more satisfying than either of those things!

Kate

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hey little debbie girl of ours;... you just hang in there. We are usaf

21 years and have fought tricare every step of the way for years. Won

some, lost some. But the point is, keep going. If this is what you

want, you redheaded child, will find a wy.

we have been told that a lot of USAF surgeons have been told to

schedule surgury only for enlisted--they are gearing up for wartime I

am sad to

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Ahhh Debbie......I am so sorry, this whole insurance business is such a

royal pain in the A--!! It really rots to have such important stuff to us

hang on the whim of someone else and feel like our hands are tied......maybe

if enough people " revolt " something will change......... P.

Bad News

> MAN I am really bummed OUT! I found out today that even if I have

> medical reasons for having plastic surgery that Tri Care won't pay for

> it and that they aren't doing PS at the Army Hospital near me any more.

> THIS sooooo pisses me off!!! Others who have had GB and have tricare get

> PS......but when I finally decide that I have had enough (they are

> putting me on maintance doses of antibiotics now!!!!! One

> daily....@*#*($*@#)) Opps sorry. :-)) I can't get it done. It just isn't

> fair. THEY willingly let you have GB knowing FULL well that the majority

> of us will NEED PS eventually. Even if I document EVERY little pain,

> ache, rash, infection.....I was told that I could see my Doc till the

> end of time, but that Tricare won't pay for PS. I am so tired of

> constant infections.....and antibiotics......and now

> this.......sorry.....don't mean to dump, but this has really gotten me

> upset. I know others are in the same boat. Funny how it becomes more

> important when it is happening to you. I have never had to worry about

> what tricare would or wouldn't pay for.....I NEVER ask for anything that

> I might NOT need.....have always been the good little girl and tried to

> work within the system. Now the system jumps up and bites me in the

> butt!!!!!! Heaven knows......I have enough skin on my BUTT for them to

> BITE!!!!!!

>

> Debbie in Gig Harbor

>

>

>

>

> Homepage: http://groups.yahoo.com/group/Graduate-OSSG

>

> Unsubscribe: mailto:Graduate-OSSG-unsubscribe

>

>

>

>

>

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YES, that's the spirit........I knew you had it in there.....you go

girl!!!!! P.

Once I get over my BOO-HOOING.....I get mad.....you don't want to

make me mad.

Debbie in Gig Harbor (GO AHEAD make MY DAY!!!!!! )

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Thanks , I knew this list would understand. I got home today from

visiting my Family Practice doc.....and I am feeling very YUCKY

anyways....(Damn Cipro!!!) .... And just wanted to cry. I have been such

a wimp about all this Reconstructive Surgery (see I do learn) stuff that

I was very happy that I had finally convinced myself that it was a

necessity. I sure didn't expect the response I got. She just basically

said NO ... NO and NO. No she wouldn't write a referral for it, No they

aren't doing it at the Army Hospital that the Navy sends us to when the

Navy can't do the surgerys in house and NO I couldn't go see a civilian

doctor. (Can't see a civilian doc if you don't have a

referral......unless I am a self pay) It was like a slap in the face.

Well, I need a change of Doctors anyway.

Debbie in Gig Harbor

ladybostons@...

www.paws2print.com

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Carol A, I wish I could change insurers, but Tricare is the military

insurance. The military doesn't give you choices. And since I don't pay

for my insurance (my ex does) I am sorta stuck between a rock and a hard

place.

Debbie in Gig Harbor

ladybostons@...

www.paws2print.com

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bbbbbbbbbbut, they HAVE! I know some who've been done at Madigan!

Thanks,

Vitalady T

www.vitalady.com

If you are interested in PayPal, please click here:

https://secure.paypal.com/affil/pal=vitalady%40bigfoot.com

Bad News

> MAN I am really bummed OUT! I found out today that even if I have

> medical reasons for having plastic surgery that Tri Care won't pay for

> it and that they aren't doing PS at the Army Hospital near me any more.

> THIS sooooo pisses me off!!! Others who have had GB and have tricare get

> PS......but when I finally decide that I have had enough (they are

> putting me on maintance doses of antibiotics now!!!!! One

> daily....@*#*($*@#)) Opps sorry. :-)) I can't get it done. It just isn't

> fair. THEY willingly let you have GB knowing FULL well that the majority

> of us will NEED PS eventually. Even if I document EVERY little pain,

> ache, rash, infection.....I was told that I could see my Doc till the

> end of time, but that Tricare won't pay for PS. I am so tired of

> constant infections.....and antibiotics......and now

> this.......sorry.....don't mean to dump, but this has really gotten me

> upset. I know others are in the same boat. Funny how it becomes more

> important when it is happening to you. I have never had to worry about

> what tricare would or wouldn't pay for.....I NEVER ask for anything that

> I might NOT need.....have always been the good little girl and tried to

> work within the system. Now the system jumps up and bites me in the

> butt!!!!!! Heaven knows......I have enough skin on my BUTT for them to

> BITE!!!!!!

>

> Debbie in Gig Harbor

>

>

>

>

> Homepage: http://groups.yahoo.com/group/Graduate-OSSG

>

> Unsubscribe: mailto:Graduate-OSSG-unsubscribe

>

>

>

>

>

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bbbbbbbbbbut, they HAVE! I know some who've been done at Madigan!

************************************************************************

*************************

Yes I know they have, because I am friends with someone who had it done

at Madigan. BUT......and this is a BIG but (not BUTT thank you very much

) Her reconstructive surgery was done BEFORE Sept. 11, 2001. AND

They really messed it up! Quite honestly the Reconstrutive Surgeon

didn't WANT to work on her........and he didn't do a very good job. NO

WAY I want to have Reconstrutive Surgery at Madigan. However, I figured

I would go through the hoops.......listen to them tell me they didn't

have room....or I didn't qualify... And then go for a second opinion

with a civilian. The chances were that the civilian doctor would be able

to help me....and willing also......however....If I can't get a referral

I can't go see a civilian.So.....I have to change my family practice

Doc. And then see where we go from there.

Debbie in Gig Harbor

ladybostons@...

www.paws2print.com

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Debbie,

Here's what happened to me originally. I, by the way, had been a military

dependant from birth! When I had WLS, which was paid for 100%, we were told

to wait two years to have PS. This was by our surgeon and a plastic surgeon

that worked closely with him. This two year time frame was to allow

everything to be settled where it would, skin wise. I guess it should have

been my own responsibility to check out what TRICARE's rules were. At two

years, I had moved and gotten into the Family Practice Clinic in Pensacola.

You know it takes almost a yr. to get into that....I was approved in two

weeks. Us WL patients are quite interesting to Family Practice. Anyway, I

asked about having PS, as this IS included in the original WLS. Oh, to my

disbelief, it was only allowed during the first year after the original

surgery. Tricky devils! So, I was refered to an Air Force base in Biloxi

(sp). They did PS on a regular basis. All they wanted was pictures mailed to

them with no documentation. Of Course, I was denied!

What you are going to have to do is fight it out. I didn't persue it long

since I was going through a divorce and would no longer be a military

dependant. Here I sit, going on 10 yrs PO finally getting my PS. It is

considered medically necessary. For yourself....investigate every avenue. I

am sure you can find the loop hole and get it paid for.

http://www.mytricare.com/tric_content.nsf

This is the contents of the Champus handbook. I could not find PS approval

after WLS. They must have changed things since I had surgery. Keep trying!

I'm sure some how, they must help you.

Good luck!

Dawn

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This is just a suggestion and I am not sure how accurate it is but most

insurance companies really freak at the term plastic surgery. However,

if it is presented as reconstructive surgery, they some how comprehend

that. It may mean only a fraction of a difference but it really is just

a fraction that we may need for them to say yes.

Lori Owen - Denton, Texas

CHF 4/14/01 479 lbs.

SRVG 7/16/01 401 lbs.

Current Weight 339.5 lbs.

Dr. Ritter/Dr. Bryce

On Wed, 8 Jan 2003 16:16:32 +0100 " Dawn Conner-Jeppesen "

frwhlngrl@...> writes:

> Debbie,

>

> Here's what happened to me originally. I, by the way, had been a

> military

> dependant from birth! When I had WLS, which was paid for 100%, we

> were told

> to wait two years to have PS. This was by our surgeon and a plastic

> surgeon

> that worked closely with him. This two year time frame was to allow

> everything to be settled where it would, skin wise. I guess it

> should have

> been my own responsibility to check out what TRICARE's rules were.

> At two

> years, I had moved and gotten into the Family Practice Clinic in

> Pensacola.

> You know it takes almost a yr. to get into that....I was approved in

> two

> weeks. Us WL patients are quite interesting to Family Practice.

> Anyway, I

> asked about having PS, as this IS included in the original WLS. Oh,

> to my

> disbelief, it was only allowed during the first year after the

> original

> surgery. Tricky devils! So, I was refered to an Air Force base in

> Biloxi

> (sp). They did PS on a regular basis. All they wanted was pictures

> mailed to

> them with no documentation. Of Course, I was denied!

>

> What you are going to have to do is fight it out. I didn't persue it

> long

> since I was going through a divorce and would no longer be a

> military

> dependant. Here I sit, going on 10 yrs PO finally getting my PS. It

> is

> considered medically necessary. For yourself....investigate every

> avenue. I

> am sure you can find the loop hole and get it paid for.

>

> http://www.mytricare.com/tric_content.nsf

> This is the contents of the Champus handbook. I could not find PS

> approval

> after WLS. They must have changed things since I had surgery. Keep

> trying!

> I'm sure some how, they must help you.

> Good luck!

> Dawn

>

>

> Homepage: http://groups.yahoo.com/group/Graduate-OSSG

>

> Unsubscribe: mailto:Graduate-OSSG-unsubscribe

>

>

>

>

>

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I have been diligently practicing using the words Reconstructive

Surgery. Shoot I have been DREAMING those words. Once I decide on

something.......I get very single minded. LOL I want to THANK everyone

for their encouragement.....that got me past the .....OMG......more

surgery?...........NOT ME! To: Damn the torpedoes, full speed

ahead!!!!!! I am taking baby steps to help reach this goal. Have found a

Psychiatrist (thanks Ceep for explaining to me what was what and who was

who) to help balance my meds........cause heaven KNOWS my Family

Practice Doc wasn't much help. (Ok....cut her some slack....she did

WRITE the referral for a Psychiatrist and not a Psychologist). My next

step is to get a new Family Practice Doc. I was finally told the KEY

word by a very NICE ER Doc....he said......I need STAFF ... Not a

resident! I have NEVER known what to ask for. So...now I know. Lets HOPE

that the STAFF has some openings. Once I get a new family practice

doc.....then I work on the Reconstructive Surgery issue.

Plans.......see....... You guys have encouraged me.....and now I have

PLANS!!!

Oh yeah.........thanks for getting me through the Holidays. Wasn't one

of my BETTER years.

Debbie in Gig Harbor

ladybostons@...

www.paws2print.com

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