I can't say for sure, but I can tell what happened at mine. I had to do 6 months of diet & nutrition appts to be approved by insurance. At my first appt, I had to do blood work, a stress test, ekg, and ultrasounds of my legs. My next appt I had to do a trans-nasal endoscope. I also had to do a sleep study to check for sleep apnea. The rest of my appts have been talking to nutritionists and dietitians discussing changes I've made and ways to make changes ongoing. Hope that helps! And good luck!