My insurance required 6 months in a medical weight loss program. I met with the PA and dietician alternating months. I had to have the psych eval and some bloodwork and when the PA felt I was ready I met with the surgeon. I actually met with the surgeon last week Thursday, they sent everything to the insurance for approval, I got an approval letter in the mail on Monday and scheduled my surgery on Tuesday. The whole process was actually pretty easy and seemed to go really fast!