Formal PEB Denying My Request For Surgery

[HGlenn]

I will just say outright that I am close to the end of my FPEB. I have (hopefully) a few months left.

I have medical documentation, stating that my Ortho Surgeon suggests I receive an operation on my left knee. I have gone to the Emergency Room multiple times, unable to sleep or do anything because of the pain I am in. They gave me medicine and crutches and told me to see my surgeon. My Legal Team told me, if my Ortho Surgeon emails the PEB, then I would be able to get the PEB put on hold, and I could have surgery, recover and resume the PEB. However after an email the PEB said, "It's elective, you can't have it. It has to be Loss of Life or Limb."

Am I missing something here? Or does the PEB legitimately expect me to live the rest of my life going to the Emergency Room for pain medication and walking around (well... not walking) on crutches because my surgery is just "elective". It just does not make sense to me that I can be controlled that much, and it's frustrating. Why are they allowed to deny my surgery? Why is it that I have to be at the stage where my leg is about to fall off for it not to be elective? Is there any way I can use this to my advantage?

I might just be ranting, and I just need to suck it up and push on through. But I've been sucking it up for the past year and a half and it's getting old real fast. I would appreciate any advice that anyone has.

Thank you.

 

[Provis]

I will just say outright that I am close to the end of my FPEB. I have (hopefully) a few months left.

I have medical documentation, stating that my Ortho Surgeon suggests I receive an operation on my left knee. I have gone to the Emergency Room multiple times, unable to sleep or do anything because of the pain I am in. They gave me medicine and crutches and told me to see my surgeon. My Legal Team told me, if my Ortho Surgeon emails the PEB, then I would be able to get the PEB put on hold, and I could have surgery, recover and resume the PEB. However after an email the PEB said, "It's elective, you can't have it. It has to be Loss of Life or Limb."

Am I missing something here? Or does the PEB legitimately expect me to live the rest of my life going to the Emergency Room for pain medication and walking around (well... not walking) on crutches because my surgery is just "elective". It just does not make sense to me that I can be controlled that much, and it's frustrating. Why are they allowed to deny my surgery? Why is it that I have to be at the stage where my leg is about to fall off for it not to be elective? Is there any way I can use this to my advantage?

I might just be ranting, and I just need to suck it up and push on through. But I've been sucking it up for the past year and a half and it's getting old real fast. I would appreciate any advice that anyone has.

Thank you.

The PEB doesn't care about you. They care about themselves. You are just another number. A cog in the wheel of their process. They just want you to suffer through it until they are done with you.

If your Ortho Surgeon states its medically necessary to have the surgery immediately and puts that in writing it would help a little. With that in writing you could raise a stink with a congressional inquiry etc. At the very least might set you up for a BCMR later on for adding that condition as unfitting if its not already.