Thank you for your question regarding whether it would be appropriate for you to have a panniculectomy with still such remaining fat and rashes. Insurance coverage for a panniculectomy depends on your insurance company and their policies. Some insurance companies are very strict on their criteria other some insurance companies are more liberal. However, in general, most insurance companies require the abdominal pannus completely cover the entire pubic region. You also must be able to document chronic rashes that have not healed with topical creams, lotions, antifungals, and antibiotics. Some insurance companies also have criteria regarding significant weight loss. If you lost more than 100+ lbs with diet and exercise, you must be at a stable weight for 6 months. If you lost more than 100+ lbs with weight loss surgery, then your weight must be stable for 18 months. However, it is important to check with your individualized insurance company. Most insurance companies do not cover a panniculectomy solely for back pain. In your case you could have a panniculectomy even with this much fat left. Some insurance companies require you to be a certain Body Mass Index or BMI for surgery. Your BMI is based on your height and weight. Please consult a plastic surgeon who is experienced with insurance coverage for a panniculectomy. Thank you for your question regarding the panniculectomy. I hope that I have answered your questions whether you could have panni with so much fat left to help with rashes. I specialize in reconstructive plastic surgery after weight loss. If you have any more questions regarding the panniculectomy, extended lower body lift, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact my office. Since the panniculectomy or lower body lift is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or lower body lift. Do your research. Make sure they have performed at least 100 panniculectomies or circumferential lower body lift surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced, panniculectomy or lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)