My insurance company required 6 months of appointments and testing with the surgeon, nutritionist, psychologist, cardiologist and probably others that I blocked out since it was 4.5 years ago. Other insurance companies required 3 months or up to a year of pre surgery services to determine preauthorization. The hardest requirement was having to write a 2 page letter explaining why I wanted the surgery. You have completed all the required steps and a doctor would not make you go through all that if they had any indication that you would not be approved. I think of it as more of a checklist, things that need to be completed before the surgery takes place.