Florida Blue — Denial Rates & Appeal Data
Compare against every insurer we track: denial rates ranked within reporting cohorts.
COVERAGE RIGHTS ROLLUP · CALCULATED FROM FLORIDA BLUE PUBLIC DISCLOSURES
Florida Blue posts per-contract percentages only (no request counts). Rates shown are enrollment-weighted averages of its two Medicare Advantage contracts (H1035, H5434; ~109K enrollees; weights: CMS Monthly Enrollment by Contract, July 2026). Marketplace issuers are reported separately and not included.
UNDERLYING SOURCE: FLORIDA BLUE CMS-0057-F DISCLOSURE, CY2025 · VIEW SOURCE ↗ · METHODOLOGY
Metrics by contract / plan
| Contract / plan | Line | Requests | Denied | Appeals overturned | Avg decision | Source |
|---|---|---|---|---|---|---|
| H1035 · FL | Medicare Advantage | n/r | 9% | 55% | 2.1d | Source |
| H5434 · FL | Medicare Advantage | n/r | 8% | 56% | 2.3d | Source |
| 16842 · FL | Marketplace | n/r | 5% | 28% | 0.99d | Source |
| 30252 · FL | Marketplace | n/r | 1% | 30% | 0.2d | Source |
What these numbers mean for your denial
Coverage Rights calculated a 8.4% prior-authorization denial rate for the Medicare Advantage contracts in 2025. In the calculated Medicare Advantage contracts appeal scope, 55.6% were reversed — most denials that got challenged did not survive review. The underlying contract or plan figures were published by Florida Blue; Coverage Rights performed the stated rollup.
The practical takeaway is narrower: an initial denial can change on review. These aggregate rates describe past decisions within the stated reporting scope; they do not predict the result of an individual appeal.
Your appeal deadline depends on your plan type
Florida Blue runs several kinds of plans, and the appeal rules follow the plan, not the insurer. Find the ladder and the deadlines for yours:
Common questions
What is Florida Blue's prior authorization denial rate?
Coverage Rights calculated a 8.4% prior-authorization denial rate for the Medicare Advantage contracts reporting scope in 2025, using the public disclosure required by federal rule CMS-0057-F. Within the calculated Medicare Advantage contracts appeal scope, 55.6% were overturned.
How do I appeal a Florida Blue denial?
Start with the appeal instructions in Florida Blue's denial notice. An independent external, fair-hearing, or Medicare review may be available after the required internal review, but eligibility depends on the coverage program, plan funding, denial type, regulating jurisdiction, and whether the notice says internal review is exhausted. Use the pathway tool before choosing the next reviewer.
Where do these numbers come from?
Coverage Rights calculated the displayed rollup from Florida Blue's public CMS-0057-F disclosures for 2025. The methodology note identifies the included reporting scope and weighting or aggregation method; source links lead to the underlying insurer-published records.