It can take insurance companies a variable amount of time to approve top surgery. The approval process generally starts with the submission of a letter of medical necessity, which is then reviewed by a panel of doctors. If the panel approves the surgery, it will be covered by insurance. However, if the panel denies coverage, patients can appeal the decision. The appeals process can take several months. Ultimately, it is up to each individual insurance company to determine how long it will take to approve or deny coverage for top surgery.