I had to have 90 days with a nutritionist before my insurance would approve and then I had to have my family doctor recommend I had the surgery. In addition, the surgeon required a psych appointment along with 3 group counseling sessions - all standard for sleeve patients. Once everything was completed - and only then - would they submit to insurance. Insurance came back less than a week later with approval and then the surgery was scheduled. I had no surprises - everything was well mapped out and went as planned. Good luck with your insurance and surgery. Btw - I started the process on 8/30/18 and had my surgery on 1/10/19.