To get a panniculectomy approved by insurance most insurance companies require that certain things be documented to prove medical necessity rather than a purely cosmetic reason for performing the procedure. These criteria often include documentation of a rash in the skin folds (intertrigo) that persists despite medical treatment with anti-fungal powders, and pictures that demonstrate the excess skin hanging down below the pubic bone. When submitting, pictures are worth a thousand words so make sure you take pictures of any skin rashes, folliculitis, boils, or cracking that may develop. A submitted note from a dermatologist that supports and recommends the procedure as medically necessary can make it harder for the insurance companies to deny.