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I have United Health, under a PPO plan. Approval is pretty much based on what was written in your policy through your employer, so they decided what is necessary for you to be approved. With mine, I only needed a 5 year BMI of 40+ and if it was lower than 40, I needed some co-morbidity conditions and a few extra requirements that were needed from the surgeon to do the surgery. My insurance would have gone through faster, but I had to clear up my pre-existing situation and provide my Certificate of Coverage from my employer before that.