I checked several clinics around here (SE VA), and they all had fees (ranged from $495-$750). I think most surgeons want to make sure the surgery is as successful as possible, so they want to educate us. My surgeon, if I'm approved, requires two support group meetings, a "wellness"(read: fitness & nutrition) seminar, a book they wrote (3 ring binder w/ about 100 pages of info), a pre-surgery preparation seminar, and membership to the hospital fitness facility. Of course, these classes also meet insurance requirements. I guess bottom line is that the insurance company wants to make sure they aren't wasting their money, and surgeon doesn't want his liablity insurance going up!