Buried Under Medical Debt

Jennifer Liss
October 23, 2006

January looked to be the beginning of an exciting year for Logan Roberts. A recent college graduate, the twenty-six-year-old started a contract IT job in Atlanta. He was engaged. Having worked construction to put himself through school, Roberts was debt-free. Because he had just started working, Roberts didn't have health insurance -- yet. But he wasn't concerned because he'd always been in great health.

Then one afternoon, his stomach began to cramp. The pain increased and soon became unbearable. He checked himself into a public hospital where his appendix was removed. Twenty-four hours later he was released.

And then the bill came. $22,000.

"When I received it, honestly, I laughed," he recalled. "'You've got to be kidding me,' I thought."

According to a Commonwealth Fund report [PDF] released this year, 35 percent of young adults -- insured and uninsured alike -- report problems paying their medical bills. And one in five young adults report having to pay off medical debt over time.

"Educational debt in some ways is expected," said Mark Rukavina, executive director at The Access Project in Boston. "It can be quite substantial and difficult to manage, but [education] is generally something people do of their free will. It is sometimes called 'good debt.'"

"Medical debt," he continued, "is unexpected and involuntary."

According to Rukavina, medical debt can also be "contagious," when the resources of family and friends are tapped in an effort to help a loved one. And financial burden, he said, is just one side of the coin. The other side is greater health risks: people who are already in debt often delay getting much-needed health care to avoid incurring more debt.

Logan Roberts was part of the 38 percent of college graduates who are without health insurance during their first year post-graduation. And even while making $200 a day and depleting his nest egg, he couldn't begin to make a dent in his medical debt.

"I wrote the hospital an email," he explained. "I said 'I appreciate the surgery. I'm not trying to get out of paying you what you deserve, but you need to reduce it or you'll finish getting paid in 30 years.'"

He went online looking for help and discovered something shocking. Because he was uninsured, the hospital was charging Roberts an inflated rate, significantly higher than what an insurance company would have been charged for the same services if Roberts had been insured.

Andrew Cohen, community research coordinator with The Access Project, explains that inflated rates are common practice [PDF]. He believes that most hospitals don't expect to ever receive the full amount charged to uninsured patients. The costs hospitals suck up are then written off as charity-care. Cohen said that even insured patients are often charged inflated rates for services that are not covered by their insurance.

When Roberts called The Access Project, Cohen counseled him on how to negotiate his bill with the hospital. Some of the tips Cohen offered included: Get an itemized bill. Speak to a manager, not a clerk. Ask if they have a charity care program. Tell them what you can afford. Come up with a payment plan. Arm yourself with the appropriate information. Advocate for yourself.

Cohen believes bill negotiation is a "win-win" situation: By working with patients who want to pay but can't afford the full bill, hospitals receive more money than they expect and patients get to save their credit rating.

"Just about everyone who calls me is surprised by the extent that this kind of self advocacy really works," Cohen said. "I found that the young people I work with respond really well to this kind of advice. That they can raise their voice and they will be heard."

Self-advocacy worked for Roberts. He ended up paying a fraction of his initial bill: $4,900. But still, he nixed his honeymoon, scaled back on his wedding, and couldn't afford a kitchen table for the first few months of his marriage. And he applied for credit cards -- for the first time -- to start paying off debt.

"My mentality is that nothing in life is free, and it shouldn't be or you take it for granted. I didn't mind paying a bill, I just didn't want to pay an inordinate bill," Roberts explained. "I was stressed out. My wife was stressed out. It punched us in the gut, but it didn't kill us."

Advocates for fair health care stress that medical debt is a problem for both the insured and uninsured. But the uninsured and the poor are at a greater risk. Young people are uninsured for a variety of reasons: they just graduated from college or high school and don't have work (or extra money for insurance); they work part-time or as contract workers; or they're kicked off their parent's insurance when they turn a certain age. Almost 14 million 19- to 29-year-olds lack health coverage, and almost half of them are paying off medical debt, according to the Commonwealth Fund.

Insurance policies built on sand

"Kate," who requested that her real name not be used, was insured when her medical crisis began. In August 2005, the small company in Massachusetts where her husband worked began offering health insurance. An insurance company representative met with employees and their families to discuss their new policy.

"He sat in my house and repeatedly said that we would have no deductible, no co-payment, that we would be able to see any doctor we wanted," Kate explained, her voice breaking. "If you read the contract, it is very confusing. I asked a bunch of questions, and he didn't really answer."

Over the following year, bad health plagued Kate, who is 22-years-old. She had a miscarriage, followed by a difficult pregnancy, followed by a very serious gall bladder infection. Kate said that insurance representative told her that her coverage would begin Sept. 1, but at the hospital, when she was miscarrying, she was told her coverage would not be activated until Nov. 1. Over the course of the next year, her insurance covered a fraction of what she understood it would cover.

Kate and her husband owe $40,000. And they are expecting more bills.

Before getting pregnant, Kate saved and prepared. "We thought we were safe. We had no debt. We wouldn't have had her (the baby) if we didn't have the money."

Misunderstanding insurance policies (or being misled) is quite common, said Rukavina. Policy language, he said, can be very ambiguous and opaque. Often, Rukavina said, people don't even read their policy, which stays filed in the HR department of their company. Instead, they read the brochure; the language is easier to understand but the information is not complete.

"The devil is in the details with insurance," said Rukavina.

The Access Project is currently researching "junk" policies, or "leaf" policies, in which the customer, like Kate, is covered for practically nothing. "People often pay [their insurance company] religiously for years," Rukavina said, "and then get paid nothing once they get sick."

When asked if she has considered looking into legal action against her insurance company, Kate sighs. "I don't know how. I don't even know where to go. We don't even have a leg to stand on. We can't afford a lawyer. We can't take a chance we're going to owe more."

Sarah Collins, senior program officer at The Commonwealth Fund, said that there is a misconception that young Americans don't use as much health care as older people. "It can be something as simple as pregnancy. There are 3.5 million pregnancies among the 19-29 age group each year," she said. "Just because people are younger doesn't mean they don't use the health care system. Even the cost of something like a pap smear or a throat culture...can be really high."

Kate tries to negotiate with the hospitals and the insurance companies. But in many ways, she feels like she's already lost. "Planning how to get the hospital to bring down the debt is very time consuming. I have to call them all the time. I have a 7-week-old. And I get kind of heated when I talk to the hospital. I don't want to scream around the kid. I feel totally trapped. It is not like a car or a house, if you are sick you need to go to the doctor. You need to go to the hospital."

Rukavina explained that people purchase health insurance for two reasons: to improve their ability to access care and to protect themselves from financial ruin. Unfortunately, he said, even people with health insurance often face disabling debt. And while the individual patient can learn how to advocate for his or herself, the problem is systemic.

With this year's elections on the horizon, health care ranks near the top of the list of issues Americans of all ages are concerned about. Rukavina suggests that now is an ideal time for young people to demand that candidates articulate their positions on affordable health care and the federal and state regulation of insurance companies. And more importantly, the elected officials must be encouraged to keep their promises after November 7. It is so unfair for anybody to suffer financially who is already suffering, by struggling and dealing with illness. They are struggling financially for no other reason than they got sick.


Jennifer Liss is a writer living in San Francisco.


#

tags

26

Comments

I have a solution to medical debt. Please buy and read my just published book. "REVENGE AT HIGH TOR" we hae a secret economic system that could make us all affluent that nobody knows about. Available at <br />
Charles H. Seitz

Levitra Long Term?Effects Kamagra Oral Jelly Vrouwen Cheap Xanax And Viagra Uk [url=http://brandciali.com]where to buy cialis online safely[/url] Articulo 186 Priligy Pills In India Propecia Valor

20180929lcktory burch outletecco shoesferragamo outletpolo outletcheap nhl jerseysuggs outletadidas trainerskate spade outletchrome hearts outletmichael kors outletcavaliers jerseyscoach outlet onlineray ban sunglassesmichael kors walletssan francisco 49ers jerseyscoach outletpacers jerseyscoach outlet onlineheat jerseyslongchamp outletray ban outletray ban sunglassesugg bootspandora charmsugg bootscoach factory outletchristian louboutin outletceline outletair jordan release datesmichael kors outletfive fingers shoesstephen curry shoesair jordan 12cheap jerseyssuicoke sandalscanada goose jacketsdansko shoesmichael kors outletcheap jerseyschristian louboutin outletfitflops sale clearanceair max 1gucci outletspurs jerseysugg outletmulberry bagsair jordan 4mishka clothinghermes outletmichael kors outletcheap jordanscanada goose outletrockets jerseysmcm outletcoach outletprada shoesmichael kors outletminnetonka outletugg outletscanada goose outletmulberry handbagsferragamo outletnike lunarglidecazal sunglassesadidas outletcoach outletfitflops sale clearanceferragamo shoesralph lauren outletgucci outletfutbol barataslacoste soldescoach canadauggs outletlongchamp soldemichael kors outletugg boots clearancecanada goose jacketsmichael korsworld cup jerseysugg bootsair jordan 3true religion jeanshouston texans jerseyscheap jordanscoach outletcoach outletred bottom shoescheap snapbackscoach outlet onlinecheap jordansprada sunglasseschristian louboutin boutiquekate spade outletpolo ralph laurencoach outletvan cleef & arpels jewelryoakley sunglassescoach outletmoncler outletdior outletred bottom shoesmichael kors outletugg bootsdenver broncos jerseysburberry outletpandora charmspandora charmsbirkenstock sandalscheap jordanscoach outletmavericks jerseyskate spade outletair max 90giuseppe zanotti outletpolo ralph laurennuggets jerseyskate spade outletwizards jerseyspolo ralph laurenpalladium bootspandora charmsnobis outletugg outletnike air max 2015louboutin pas chercoach outlet onlinesuns jerseyssoccer shoescanada goose coatskate spade outlettrailblazers jerseysugg bootstrue religion jeanspandora charmscoach handbagsknicks jerseysbvlgari jewelryoakley sunglassescoach outletcanada goose jacketsmiu miu handbagscheap mlb jerseysugg outletmichael kors outletsoccer jerseysmichael kors outletnike revolutionhermes beltuggsfitflops outletjazz jerseyssalomon shoestory burch outletcheap football shirtscanada goose outletoakley sunglassesmont blanc pensuggs outletpandoraugg bootsugg outletcamel shoesair max 97michael kors outletugg boots clearancemichael kors outletswarovski outletmichael kors outletnew york knicks jerseypandora jewelryralph lauren poloair maxpolo ralph laurenbalenciaga sneakerssupreme clothingmichael kors outletugg outletmulberry outletuggs outlettory burch outletmulberry handbagssoccer jerseysmichael kors outletcoach outlet store onlinetoms shoescheap jordanskobe bryant shoespelicans jerseysbucks jerseysswarovski outletcolumbia sportswearugg bootscanada goosemalone souliers mulescanada goose outletnike store ukbaltimore ravens jerseysugg outletfred perry polo shirtscanada goose outletfootball shirtsubiq shoesnba jerseystory burch outletugg outletugg outletmoncler outletpandora charmsray ban sunglassespistons jerseysuggs outletjordan shoesyeezy boost 350converse shoesmichael kors outlet onlineralph lauren polo shirtsuggs outletcanada goose outletkobe shoespolo shirtsmichael kors outlettrue religion jeanslakers jerseysdc shoeslongchamp handbagsmichael korsmulberry handbagsray ban sunglassesmulberry bagsgrizzlies jerseyspandora jewelrychristian louboutin storenhl jerseyscheap jordansmagic jerseysuggs outletmbt shoesugg outletair force 1michael korscoach handbagskate spade outletnike prestocanada goose parkatrue religion jeanscoach outletmoncler outletmichael kors outletfitflops saleferragamo outletray ban sunglassespolo ralph laurencoach outletugg bootsadidas nmdkate spade outletuggs outlettrue religion ukjeep shoescheap jordanscanada goose outletralph lauren pas chercanada goose jacketsle coq sportif shoeschicago blackhawks jerseysnike shoescheap jordanstrue religion outletpandora charmskate spade outletmichael kors outletcanada goose outletcoach outlet onlinenhl jerseysair max 90ugg bootssaucony shoescanada goose jacketsasics shoescoach outletcoach factory outletcoach outletnike freechristian louboutin outletpolo ralph laurenindianapolis colts jerseyscoach outletugg outletred bottom shoeschristian louboutin outletmoncler jacketspolo outletswarovski outlettory burch outletcanada goose coatssupreme clothingnike dunkssimulation shoesmulberry handbags20180929lck

2018.10.12chenlixiangadidasadidas outletmizuno running shoeslululemon outletnike free runair max 2017givenchy bagsburberry handbagsfurla handbagsbeatsbasketball jerseyburberry outlethoganadidas slidesmichael kors outleta bathing apecelineadidas running shoesmoncler jacketsconversechristian louboutinnike shoesbvlgari sunglassesmichael kors handbagsnike air maxmichael korsdiesel jeansgermany world cup jerseyadidas clothingsalomon shoesgiannis antetokounmpo jerseymiu miu shoesadidas outletnike air max 90nike air forcebottega venetacoach outlet onlineadidas trainersclarks shoesnfl jerseyscheap nfl jerseysguessoakley vaultnike outlet storenike clothinghollisterreebokray ban sunglassesseahawks jerseyslongchamp handbagsnike blazerkevin durant shoesuggs outletmanolo blahnikskechers shoesdolce & gabbana sunglasseskobe 11moncler jacketsjordan 10bose headphonesvans shoesjordan clothinggucci outletadidas outletnike freehermes jewelrycartier sunglassesspain world cup jerseysac longchampadidas zx fluxjordan shoesray ban outletburberryoakley vaultmichael kors outletnike air max plusray bannike air max 2018ralph lauren outletharry winston jewelrycoach outletparajumpersmontre pas cheradidas soccer cleatsjordanspuma shoesoakley sunglassessoftball batsmichael kors canadahufchampioncurry 3jordan shoestory burch outlettimberland bootsnike air force 1salvatore ferragamomontre pas cherlongchamplouboutin pas cherarmani sunglassesbeats headphonesalexander mcqueennike roshe runkaren millenair max 90michael kors outletdesigner sunglassescalvin kleintimberlandroshe runferragamosoccer jerseysgucci bagshermeskd 10 eliteprada outletmarc jacobs handbagsnike blazerdansko shoeskd 910 deep clothingbrazil world cup jerseyinstyler ionic styleradidas ukasicsoakley sunglassespandora jewelryray banlinks of londonpandoraflip flopsferragamobottega veneta sunglassesjordan 6ed hardyburberry sunglassesnike air max 95true religiontrue religion jeansferragamo beltair max 97chanel handbagsmarc jacobs handbagsnike air maxnike air max 90portugal world cup jerseycheap oakley sunglassesreplica watchescoach outletrswarovskiswarovskilouboutinjordan 1tods shoeslouboutinroshe runinsanitycartier love braceletkobe 9bcbg maxnike outlet onlinepolo ralph laurengentle monster sunglassesfendiair more uptemponike air maxjordansadidas soccerkids jordansnike canadanike air maxadidas outlet storeoakley sunglassestimberlandkate spade outletwedding dressesrolex watchesralph lauren outletjimmy choo sunglassespolo ralph laurenferragamo shoesmontrejordan 2kate spade outletisabel marantlongchampkevin durant shoesbasket nikemac makeupmichael kors outletburberry outletgiuseppe zanottisoccer shoesrolexred bottomsbarbourroshe runsuprasac burberryoakleywedding dresseslongchamp bagsgucci beltchanelair max 95new balancenike free rungucci handbagsnike shoesnike outletomega watchesnike storerolexjordan 7michael kors outletjordansuprajordan 8tory burch outletnike outletmulberry outletburberryabercrombienike pas cherabercrombieghdnike factoryabercrombiesac guesschi flat irontiffany & copolo ralph laurenbabylissinsanity workoutair jordanarcteryx jacketsmichael korsconverse chuck taylorchrome hearts jewelrynike roshe runchristian louboutinuggs outletswarovskibulgari jewelrykobe 12uggs outletnike storeair max 90jbl speakersmont blancralph laurenjordan shoesoakleytrue religion jeansfendi sunglasseschanelugg outletkaren millen ukkeenralph laurenugg bootsjames harden jerseycarrera sunglassesnike storeasics gellebron james shoesbaseball batsray banlongchampmichael kors borsenike air forcearmani handbagsnike air maxjordan xx9jordan 14nike tnkristaps porzingis jerseyvansbasket storechloe sunglassesadidas flip-flopstommy hilfigerkevin durant jerseyjordan 9roshe runmichael kors outletoakley sunglassesdolce & gabbanabasketball shoesgoyard handbagshermes ukyves saint laurentherve legerpandora charmsair jordanair max 2017france world cup jerseytrue religion jeansnike air maxasicsmizunougg outletmadrid jerseybcbgmichael korsmichael korsjordan 4ugg outletpandora jewelrylebron 11versace handbagstommy hilfigergolden goose sneakersnike air maxiphone x casefitflops outletnike air maxpandorawedding dressesmichael kors outletpradaguessasicslouboutinbeats headphonesstuart weitzmanjordan 3armani jeansair zoom pegasusconversecalvin klein jeansvanessa brunodyson hair dryerswarovski crystalboy london clothingnike huarachecheap uggscheap tomstrue religion outletnike airlacoste jeansiphone casesghdinsanityargentina world cup jerseyjordan retrosac michael korsstuart weitzmannike roshe runfreshjive clothingaaron rodgers jerseyjordan 4schristian louboutincarson wentz jerseynike air max 90nike freenikenew balanceprada outletjordan 12sadidas crazychristian louboutinjordan 6sguessair maxray ban sunglasseschrome heartslululemon outletnike mercurialcurry 4bottega venetadolce & gabbanahogan shoesdesigner sunglassesralph laurenvansadidas superstarjordan 5sbarbourjimmy chootory burch outletnew balance shoesjordansnike foampositecanada goose jacketschloe handbagskyrie irving jerseyjordanjordan 11nike outletballymac makeupcoach handbagsbirkin bagrolex watchespandoracanada goose jacketscheap nfl jerseysfossillouboutinvalentinohermes outletjordankyrie 4dsquared2 outletconverse shoesconverse shoesconverse outlet storeengland world cup jerseyoakley glasseskenzo clothingghd hair straightenersclarisonicmizuno running shoesgivenchy jewelrycurry 5pandora jewelrycoach outletray banburberry outletreplica watchesbeats by dredior sunglassesnike kyrie 2gucci outletantonio brown jerseyjimmy choougg bootsjordan 13toms outletlongchampbalmainvibram fivefingersray ban sunglassescoach outletfendinike freehogannike vapor maxnew balancekate spade outletcoach outletabercrombiefitflopscurry 2jerseysnike air maxnike freeeagles jerseyalife clothingg-star jeansugg bootscoach pursebalenciaga shoesray banvans shoeskate spadelebron shoesnike blazer pas cheradidas outletconversesalvatore ferragamo shoesreebok outlet storejordan 32new balancemarc jacobsmac cosmeticsnike air forceray ban sunglasseschopard jewelrytimberland bootschloe handbagsnike mercurialferragamo sunglassesbapekobe 10dolce and gabbanajordanshollister outletdior handbagsmoncler outletfitflopyeezy shoesdanskoadidas outletair maxkobe 10jordantrue religion outletoakley sunglassesdak prescott jerseybelgium world cup jerseysmont blanctommy hilfigerdsquared2 jeansoakleyjordan 312018.10.12chenlixiang

philipp pleinadidas outletkate spade pursepolo outletconverse shoesugg factory outletfootball shirtssupreme clothingnba jerseysnike outletbeats by drenike cortezoakley sunglassesmoncler jacketssnapback hatsray banhermes kelly bagnorth facecoach factory outletpuma outletuggs official siteugg bootscoach factory outletcheap nfl jerseysmaillot de foothogan shoesmichael kors handbagsgivenchy handbagsray ban sunglassesuggs outletmoncler jacketspaul george shoesjordan shoesherve leger dressesoff-whitetrue religion jeansnfl jerseysnike air max 2017canada goose jacketshermes beltbottega venetaugg slipperssuperdrynike prestoray ban sunglassescoach factory outletmont blanc pensugg for mentrue religion salecoach outletmoncler outletunder armourlevi jeansburberry outletcheap nfl jerseyskate spade outletmichael kors handbagsadidas stan smithburberry outletnike freemichael korscanada goosejordan pas cherflopsnorth face outletlouboutinmbtbvlgari jewelryugg australialebron soldier 11ysl makeupswarovski ringsrolex watchesgiuseppe zanottimbttiffany ringskobe 11jordan 4adidas yeezy 350 boostuggs outletbarcelona jerseyvisconti penstodslebron james jerseyversace sunglassesugg shoesmonster headphoneslululemon outletcanada goose outlettrue religionmikimoto jewelrycoach outletjuicy couturejimmy choojordan 1ugg bootsugg outletdolce & gabbanajordan shoesferragamo beltferragamo shoesbreguet watchessoccer jerseyscoach handbagsray ban sunglassesconverse shoesjordannike mercurialcoach factory outletmichael kors handbagsugg bootsjordanjordanlouboutinray ban sunglassesnike shoesugg bootspandora jewelrycanada goose jacketscoach outlet onlinepolo shirtsfußballtrikotspolo ralph laurennike outletナイキ スニーカーvictoria's secretpolo ralph laurenflipflopscanada goose jacketsnike kyrie 2van cleef & arpels jewelrynorth face outletversace bagsmiu miu sunglassesmalone souliersnike outletugg outletmiu miu handbagscoach outletmichael kors outletralph laurenred bottomspandora jewelrycoach outlet onlineugg boots salenorth face outletnfl jerseys wholesalenike factorymichael kors canadabalenciagareplica watchesburberry salecoach outletpandora jewelrykate spade outletcoach outletprada outletadidas shoesskechers sandalsy3 shoeschristian louboutinwholesale nfl jerseysfjallraven outletbirkenstockralph laurennike kyrie 3mcm backpackadidas yeezynobis jacketsjordan 3coach outletoakley sunglasseskate spade outletmaglie calciophilipp plein outlettory burch handbagsadidas outletlebron ambassador 10ugg clearanceugg outlet storeralph laurenpandora jewelryrunning shoesprada handbagsnicholas kirkwood shoesmichael kors outletnike shoesugg saledanskougg for womenlinks of londontrue religioncanada goose salesoccer jerseypandora outletnike huarachecoach factory outletcolumbia outletoakley sunglassesversace clothingray banadidas shoescoach outletbaseball batskate spade outletchristian louboutinbalenciaga triple spandora jewelryreplica rolex watchesjordansroshe runadidas stan smithaudemars piguettory burch sandalschristian louboutin shoesnike air max 95supra shoesnike outlet storeugg bootscanada goose jacketsnike tnmlb jerseystommy hilfiger shirtsugg clearanceugg outletcamisetas de futbollongchamp outletharden vol 1vapormaxadidas nmd outletred bottom shoesugg saleadidas outletair jordansuicokemaglia calciohermes outletray bansugg bootstory burch outletcanada goose outletugg bootsmaui jim sunglassesnike air maxnike lunarglideralph laurenmichael korsnike dunksarc'teryx clothingsupremevans shoesvans outletnike air maxbirkenstock shoesnike socksugg outletstussy clothinglinda farrow sunglassesmoncler outletnike air maxoakley sunglassesray bantimberland bootsnorth facecoach outletunder armour shoesnike kd 8nike outletysl sunglassesmichael kors outletpandora charmsjordan shoesray ban wayfarersmont blanc pensoff-white clothingugg bootsmichael kors bagsnike factorymichael kors outletnike air max 1prada outletwedding shoescoach outletlebron soldier 9coach outletlebron 14woolrich jacketsadidas superstarprada bagslight up shoesbcbgronaldo jerseycoach outletnfl jerseyscanada goose coatscheap jordansbaby uggsnike flight bonafidecoach outletoakley sunglassesnike epic reactcoach outletair jordanpolice sunglassesnorth face outletmaillot de footlongchampadidas outletmlb jerseyscurry jerseyyoga pantsnike kd 10fitflopsjordan 12undefeated clothinglouboutinugg outletnike air force 1air maxralph lauren outletmichael korsmoncler outletcartier braceletferragamo shoesnike outletnike blazerprada sunglassessalvatore ferragamohermes bagsjordanscoach walletspasotti ombrellinike shoestom ford sunglassesmichael kors outletbelstaff outletray ban sunglassesugg for kidsmoncler outletsupreme pas chernike air max 97vibram fivefingersnew balancetrikots günstigdior handbagsmac makeupbaseball jerseyray ban sunglassesugg outletvetements clothingtimberlandmichael kors outlethockey jerseysmlb jerseyscheap nfl jerseysray ban sunglassesnorth face outletomega watcheslee jeansuggs salemanolo blahnikalexander mcqueennew balance sandalsadidas nmd for salepolo ralph laurenmulberry handbagsralph laurenx-large clothingmichael kors outlettrue religion outletkate spade handbagstimberlandceline handbagsmanchester united jerseyrussell westbrook jerseythe north facenike air maxfitflopsralph laurentiffany & copolo outletnike air max 2018nfl jerseysugg saleysl bagslebron soldier 10mizuno shoesjordan 6lebron 13flip flopsteva sandalscanada goose jacketschristian louboutin shoeslongchampnorth face jacketsbirkenstock sandalscheap jerseyssophia webster shoesmoncler outletmcm outletchristian louboutin outletugg australianike flip-flopsnew balance shoesadidas slidespersol sunglasseswomens ugg bootsnike air max 270marc jacobsnorth face jacketsnike sbswarovski crystalnike trainerstrue religion jeansnike shoxcoach bagsoakley sunglasses cheapmarcelo burlonlongchamp handbagsbreitling watcheslebron 15christian louboutin shoesomega watcheschristian louboutin outletyeezy shoesfingerlingsugg outletoakley sunglasseskevin durant shoestiffany jewelryjordansadidas jeremy scottnine westburberry outletparajumpers jacketspandora jewelrycoach outletsupreme clothingadidas wingsfilacolumbia outletlouboutinsac longchampuggs outletcanada goose outletvans outlethollister clothingmichael kors handbagsjordan shoesspalding basketballralph laurentag heuer watchesnike outletnike freefitflops saleray ban sunglassesnike air max plusralph laurenkate spade outletnike roshecoach handbags outletvalentino shoescamisetas de futbolmichael kors outlettiffany jewelrytory burchugg outletpandora jewelrysupreme new yorkrussell wilson jerseyhermes bagsjordan 5ray banugg outlet storebasketball shoescoach outletcristiano ronaldo jerseyuggs on salefitflopsmontblanc penlongchamp outletjordanpelikan pensconverse shoesmac cosmeticsralph lauren outletswarovski jewelrymarc jacobs handbagsjimmy choo outletnike blazerugg storenfl jerseysadidas football bootsnike huarachenike air force 1michael korsnew balancejordan xx9pandora jewelryugg salepandora charmslongchampmanolo blahnik shoestimberlandkate spade handbagsonitsuka tiger shoescheap jerseyssnapback hatsmac cosmeticspuma fenty slidescanada goose jacketssaucony shoesconverseoakley vaultbirkenstock outletadidas ultra boostugg salevalentinoshoe carnivalray banrussell westbrook shoesbasketball shoeslululemonsupra shoeshundreds clothingmoncler outletkobe 12cheap nhl jerseysair maxugg bootsnike air maxtimberlandugg bootsnike shoes for womensoccer jerseyspolo ralph laurenadidas flip flopsray ban sunglassesmichael kors ukcanada goose outletnike hyperdunkcheap soccer jerseysoakley sunglassesoakley sunglassesbeats headphonesharden vol 2ralph laurenmoose knuckles jacketsasics shoeschristian louboutinnike air max 90jordan 8oakley sunglassesralph laurenmichael kors outlet clearancenike dunksfitflopsvans shoesmichael kors pursemichael kors handbagsyeezy desert rat 500nike freepuma slidesnike revolutionjordansmichael kors handbagsmishka clothingnike tennisbalenciaga sandalsralph laurencoach outlet onlineugg bootsstuart weitzmantory burch shoesugg bootsstephen curry shoescanada goose outlethermes bagslebron 15reebok shoesjordan 11tom brady jerseyralph lauren jeanschenyingying20181019

coach outletchristian louboutin outletmichael kors outletfred perry polosuperdry clothingred bottom shoesmichael kors outletmoncler jacketschristian louboutin outletoakley sunglasses wholesaleoakley sunglassesred bottom shoespandora jewelrycheap nfl jerseysvalentino outletmcm handbagscanada goose outletcanada goose outletralph lauren outletlebron james shoesmichael kors outletmichael kors outletpolo ralph laurenchristian louboutin outletmichael kors outletmlb jerseyscoach factory outletcoach outletralph lauren polo shirtsconversenfl jerseysmcm outlethermes birkinralph lauren outletcanada goose jacketstory burch outletfitflops sale clearancetory burch outletcoach factory outletferragamo outletugg bootskate spade outletcoach outlet onlinecheap ugg bootscanada goose outletmont blanc pensugg outletkate spade outletmichael kors outletcoach outletclarks shoesmichael kors outletcoach outlet onlinekate spade outletmichael kors outletmichael kors outletcheap ugg bootsmichael kors outletadidas shoespolo outletkate spade outletray ban sunglassesnfl jerseysmichael kors outletmichael kors outletadidas superstar shoespolo outletoakley sunglassestrue religion jeansmichael kors outletcoach outletuggs canadacanada goose jacketskate spade outletnike trainerscheap nfl jerseysair jordan shoespolo ralph laurennike outletmichael kors handbagschristian louboutin outletpandora outletmichael kors outletpandora outletchristian louboutin outletoff-whitechristian louboutin outletcanada goose jacketscanada goose outletmlb jerseys wholesaleuggs outletoakley sunglassesugg outletmichael kors outletcoach outlet store onlinecheap ugg bootspolo ralph laurencanada goose jacketsmichael kors outletchristian louboutinmoncler outletmichael kors outletcanada goosemont blanc penssupreme outletuggs outletmbt shoescoach outletpolo outletoakley sunglasses wholesalenhl jerseyscheap ugg bootscanada goose jacketsair max 90michael kors outlettrue religion jeanspandora outletkate spade outletgucci outletvans shoestrue religion outletmichael kors handbagspolo ralph laurenlongchamp handbagschristian louboutin outletnike outletchristian louboutin outletcoach outletcanada goose outletmichael kors outletred bottomsray ban sunglassespandora outletcheap nfl jerseyscoach outlet onlinecoach outletnike shoesuggs canadacoach outlet onlinecheap jerseyskate spade outletcheap jerseyscoach outletmoncler outletugg bootscanada goose outletchristian louboutin shoescanada goose outletcanada goose outletadidas outletyaoxuemei20181101

coach outletclarks outletpandora outletpolo outletugg bootschristian louboutin outletcoach outletuggs outletpandora charmscanada goose jacketschristian louboutin outletchristian louboutin outletcoach outlet onlinepandora jewelrymoncler outletcoach factory outletcoach outletcoach outlet onlineuggs outletugg bootspandora charmspandora outletpandora outletcanada goose outletnike shoeschristian louboutin outletcanada goose outletcanada goose outletcoach factory outletcoach outletuggs outletchristian louboutin boutiquechristian louboutincoach outletcoach factory outletchristian louboutin shoescoach outlet canadacanada goose jacketscoach outletcoach outletpandora outletcanada goose jacketsfitflops sale clearancecoach outlet onlinepandora jewelryed hardy clothingadidas outlet onlinecoach outletcoach outlet onlineugg bootscoach outletcoach outlet onlinecanada goose jacketscanada goose jacketscoach outletcanada goose outletcanada goose outletadidas nmd shoescoach outlet onlinecanada goose outletchristian louboutin outletcoach outletcanada goose outletuggs canadaadidas yeezynfl jerseyscoach outletcoach outletcanada gooseadidas yeezy shoescanada goose outletchristian louboutin outletcanada goose jacketspandora jewelrypandora charmscanada goose outletcoach outletcanada goose outletcoach outletcoach outletcoach outletchristian louboutin outletcoach outlet onlinepolo ralph laurencoach outletlacoste outletugg bootschaussures christian louboutincanada goose outletuggscanada goose outletfred perry outletcoach outlet onlinevalentino outletchristian louboutin outletcanada goose outletcanada goose outletpandora charmschristian louboutin outletcanada goose jacketscanada goose outletadidas shoespandora outletair jordan retrochristian louboutin outletpandora outletpandora charmscoach outlet onlinechristian louboutin outletcoach outletuggs canadaclarks shoespandora jewelrycoach outletcanada goose jacketscoach outletcanada goose jacketscoach factory outletcanada goose outletugg bootspandora outletcoach outlet onlinecoach outlet store onlinecoach factory outletadidas outletcoach factory outletpandora outletprada handbagspandora jewelrycanada goose outlet storeugg outletpandora jewelrycanada goose outletcoach outletchristian louboutin outletcoach outletcanada goose jacketschristian louboutin outletnike outletchristian louboutin outletugg bootscoach outlet onlinecoach outlet onlinepandora outletnike outletugg outletcanada goose outletpandora charmspandora charmsvibram fivefingersugg outletpandora outletugg boots clearancecoach outletcoach outletcanada goose jacketschristian louboutin outletnike shoes outletcoach outletcanada goose jacketsugg bootsugg outletcanada goosechristian louboutin shoescanada goose jacketsnike shoes outletcanada goose jacketschristian louboutin outletmbt shoeschristian louboutin outletcanada goose outletchristian louboutin outletcoach outlet onlinecoach outlet onlineugg bootschristian louboutin outletcanada goose jacketslacoste polopandora outletcanada goose jacketsugg bootspandora jewelry outletugg bootscheap jerseyspandora jewelrypandora charmcoach outlet canadapandora charms sale clearancechristian louboutin outletcoach outletlacoste shirtscoach factory outletcanada goose outletchristian louboutin outletcanada goose outletchristian louboutin outletcoach factory outletmichael kors outletcoach outletcanada goose jacketsugg outletcoach outlet onlinecoach outletpandora jewelrycoach outletcoach outletcanada goose outletugg boots clearancecanada goose jacketspandora jewelrycoach outletkate spade outletcoach outletnike outletcoach outletcanada goose outletchristian louboutin outletcheap snapbackscanada goose outletcoach outlet onlinefred perry polokate spade bagscoach outlet onlinepuma outletcoach outletfitflops salecanada goose jacketspandora outletmulberry handbagschristian louboutin shoesugg bootschristian louboutin outletuggs outletcanada goose outletpandora outletcoach outletugg outletcanada goose jacketscanada goosecoach factory outletkate spade handbagspandora outletcoach outletcoach outletpandora charmspandora charmscoach outletcoach outletcoach outletcanada goose outletugg outletcanada goose outletcanada goose jacketscoach outletugg bootscoach outlet onlinechristian louboutin outletcanada goose jacketscoach outletugg bootschenlili20181213

Generique Lioresal 25mg Kamagra Laboratorio Chile [url=http://aaost.com]cialis 20mg price at walmart[/url] Purchase Prednisone Before After Using Propecia [url=http://cialvia.com]canadian pharmacy cialis[/url] Osu Acheter Cialis France Plavix Copay Discount Card Pramil 50mg

Isotretinoin secure ordering overseas [url=http://viaapill.com]viagra online pharmacy[/url] Amoxicillin Drug Interaction Affects Dove Comprare Cialis Generico Cerco Propecia Schweiz Lioresal Vente En Canada [url=http://cialibuy.com]online pharmacy[/url] Macrobid Express Delivery Shop Under The Tongue Sildenafil No Perscription Azithromocin Tablets [url=http://brandciali.com]cheapest cialis 20mg[/url] Comprar Cialis Receta Levitra Effetto Ritardante Drugstore Xenical [url=http://cdeine.com]viagra[/url] Sinequan Buy Viagra Now Online 1 Month Taking Propecia

Zithromax Sexually Transmitted Disease Viagra Danger Sante Bactrim No Prescription [url=http://cheapcial20mg.com]cialis 20mg for sale[/url] Mejor Que Viagra Kamagra Discount Code Tomar Propecia Estearato De Magnesio Viagra Online Pay With Paypal [url=http://orderlevi.com]levitra 40 mga for sale mexico beach[/url] Propecia Ciclon What Is Keflex Ed Meds Overnight Delivery Zithromax Klamydia [url=http://rxasian.com]viagra[/url] Viagra Herzinsuffizienz Propecia Generic Finasteride Clinically Proven Esperienze Cialis

Cialis Generico En Farmacias Who Makes Amoxicillin Noroxin [url=http://levicost.com]levitra billig[/url] Propecia Online Price Buy Generic Doxycycline Online

Cialis Ohne Rezept Generika Cellcept [url=http://levicost.com]vardenafil online pharmacy[/url] Pharmacyonline Omifin Cialis Por Correo [url=http://corzide.com]viagra prescription[/url] Levitra Generico Firenze Acquisto Cialis Senza Ricetta Medica [url=http://hxdrugs.com]cialis for sale[/url] Levitra Gebraucht How To Order Flagyl In Hampton Lowest Price Tadalis Sx Soft Cialis Gр с–рўв˜nstig Kaufen 40mg Cheap Brand Name Viagra [url=http://priliorder.com]priligy[/url] Cialis Funciona Siempre 50 Gel Kamagra Oral Jelly Buy Propecia England Propecia Embarazo Este Buy Priligy [url=http://cialtadalaf.com]cialis cheapest online prices[/url] Kamagra Beipackzettel Generic Propecia 1 G

Propecia Precio 1 Mg [url=http://ciali5mg.com]where to buy cialis online safely[/url] Meilleure Facon De Durer Plus Longtemps Pharmacy In Canada Viagra Kamagra Gut

Zentel Website With Free Shipping Overseas Pharmacy Amoxicillin For Ear Infections Sertraline [url=http://buycial.com]cialis 5 mg best price usa[/url] Order.Viagra Marca De Propecia Fosamax

Metronidazole 500mg Tablets Amazon Glaxomed Zithromax Buy [url=http://orderciali.com]cialis price[/url] Cialis Tab Propecia Depression Acne

Ingredients In Amoxicillin Viagra Chi Non Lo Puo' Usare [url=http://viaaorder.com]buy viagra[/url] Expired Amoxicillin

Zithromax Tooth Infection [url=http://nefoc.com]propecia engorda[/url] Online Pills Viagra Pages Jaunes Levitra

Citrato De Sildenafila 50mg Propecia Trigliceridos Levitra Medicine [url=http://cheapestcial.com]cialis 20mg price at walmart[/url] Celadrin Singapore Acquistare Kamagra Francia

Viagra Online A Basso Costo Prix Pilule Viagra En Pharmacie [url=http://genericcial.com]cialis vs viagra[/url] Viagra Gratuit Essai

Viagra Flugzeug Mitnehmen Achat Pilule Viagra En Antibes [url=http://leviprix.com]buy levitra safely from canada[/url] Cialis 20mg Vs 40mg Best Dosage Cialis generika 20mg kaufen

Viagra Esami Del Sangue [url=http://cpsmeds.com]cheap cialis[/url] Hq Canadiand Meds

Propecia Svenson [url=http://getpharmacyonline.com]cialis[/url] Zithromax Penicillin Viagra Probepackung Kostenlos Fluoxetine Panic Attacks

Amoxicillin Red Levaquin Et Amoxil [url=http://gemeds.com]kamagra que es[/url] Comprar Cialis En Canada Amoxicillin And Allergic Reaction And Baby Amoxicillin And Breast Lumps

Secure Viagra Zithromax For Ear Infections [url=http://cheapciali.com]online pharmacy[/url] Cialis 4 Stuck

Gonnorhea Amoxicillin Viagra E Doping [url=http://cialibuy.com]Cialis[/url] Buy 125 Mcg Synthroid No Prescription Cialis Mail Order Nuova Propecia Finasteride

Order Propecia Prescription [url=http://cialibuy.com]cialis[/url] Taking Amoxicillin For Tooth Nerve Cialis What Is Cephalexin Used For