About Me and Why I Work with Lipedema Women

Hi, I'm Michelle Jaqua, a Lipedema patient, a Registered Nurse for over 30 years, and a Certified RN Case Manager.

My RN Case Management Experience

In 2001, I founded my case management consultant company for insurance plans. I hired and trained nurses to provide case management services. My clients were Third Party Administrators (TPA's) and Reinsurers throughout the country.

My company offered complete case management services, including external reviews for medical necessity and interpreting plan language. I was patient advocate between members and their medical insurance. I did this work for almost ten years until insurance companies moved toward having their own in-house case management departments. After I closed my company, I continued working in the medical insurance field. I set up new case management departments for self-insured plans, and an oncology program for a medical contracting company. 

As a Lipedema patient

In 2020, I was reading an article about a woman  with Lipedema. I'd never heard of this condition, so I did a ton of research (there wasn't much at the time).  The more I read about Lipedema, the more I realized I also had Lipedema.

I got a medical diagnosis through Dr. Karen Herbst, and started on my conservative care needed for preauthorization.

My medical insurance plan did not have a coverage policy for Lipedema surgery. Regardless, I worked on getting a preauthorization for liposuction surgery. 

Working with my insurance and my surgeon's office, I was granted preauthorization, an out-of-network exception, and a single case agreement between my insurance and surgeon. 

I completed my surgeries in 2022, and am now an advocate for Lipedema women.

Today, I focus on helping women get through the insurance process to get liposuction surgery for Lipedema.

Through my extensive experience, I've developed a deep understanding of the insurance industry and a passion for patient advocacy. I use my skills and knowledge to provide expert guidance and support to my clients, helping them overcome the challenges of obtaining insurance coverage for liposuction surgery to treat Lipedema.

I write a lot about Lipedema through my newsletter Lipedemaandme.substack.com.  I also believe in the power of storytelling to connect with my readers on a personal level. That's why I'm committed to sharing my experiences and insights to help others navigate the complex world of medical insurance. With my expertise and dedication to patient advocacy, I'm here to help women with Lipedema access the care they need and deserve.

I'm also a Lipedema patient. And I've been through everything you've been through. I've been discriminated against for my weight. I've not been heard when reaching out to the medical community for help.   

I understand the struggles women with Lipedema face, including discrimination and lack of support from the medical community. I have also personally gone through the preauthorization process for Lipedema surgery, and it took me a year filled with emotional ups and downs.

When I started the preauthorization process, I was scared and overwhelmed. I had one of the worst insurance plans, a self-insured PPO plan with no out-of-network benefits and no coverage language for Lipedema surgery. I even sought help from a service that was supposed to assist me, but they only gave me incorrect advice. I felt lost and frustrated, and I knew that other women with Lipedema must be struggling too.

So, I put together my preauthorization to submit to my insurance. I worked with a case manager through my insurance company and used my years of experience in the insurance industry to navigate the process. 

The path wasn't easy! I was denied surgery twice. I had one appeal and then had the second denial overturned. I worked to get my surgeon considered in-network, even though my plan had 0% out-of-network coverage. I worked with my surgeon and insurance company to facilitate a single-case agreement.   

Despite facing two denials, I persisted and eventually received approval for both surgeries, a network exception for my surgeon, and a single-case agreement for surgery with my insurance covering the entire cost.

Why not use any other consultant who says they provide the same service?  

I specialize in guiding a patient through getting medical treatment and working with insurance to get coverage, and have been doing this type of work for decades. I have more experience in the insurance industry than most nurse case managers.   

I thought about what I'd gone through and how hard it was on me. And I knew what I was doing! I couldn't imagine how other women with Lipedema could go through this without help or, even worse, the wrong help. And the more I talked to other women through Lipedema groups and social media, the more I found that women needed real help and advocacy.   

This is why I've started helping other Lipedema women like you. I want you to have help and representation from a specialist who knows the process and has been through what you're going through right now.   

If you want me to help you through the insurance process to preauthorize your surgery, schedule a call with me! Click the button below, and let's start on your journey together!