Simplifying the claims process

May 19, 2025

At Florida Blue, we're always striving to simplify our processes to make health care more efficient and affordable. We also want to make health care experiences better for patients and doctors. One way we are doing this is by making the health care claims process easier and faster.

Claims review is often a quick process. In many cases, Florida Blue claims are approved automatically. We're proud to say that we're consistently recognized by hospitals, physicians, and leading health care organizations as best-in-class for timely review and approval.

We understand that any delay or denial can be frustrating for patients and doctors. That's why we're working to further reduce our denial rate, which is already significantly lower than the industry average.¹ We continue to invest in advanced technology and process improvements to enhance our claims processing capabilities. 

So, what is claims review? When you receive medical care, your health care provider submits a claim to your insurance company. It is then reviewed to verify the claim details, such as is the care included in your insurance plan and was the care provided by an in-network or out-of-network doctor.

If a new claim is not immediately approved, it’s usually because it’s missing information. Once that information is provided, most claims are processed quickly. If a claim is denied, it typically means more information is needed from your doctor.

The facts and figures speak for themselves. Florida Blue approves 90% of claims on the first pass. Of the claims we can’t quickly approve, most are because of a missing piece of information. In the end, it's a relatively small number of claims that are ultimately denied – and that's usually because the claims are duplicate, the member is covered by another insurance company, or the claims are for services that the plan does not cover.²

At Florida Blue, we're committed to making the health care experience simpler and more affordable. Our claims review process is one way we’re doing that. By using technology and working together with health care providers, we're transforming the way health care is delivered.

To see other ways we’re simplifying health care, learn how we are improving our prior authorization process.

¹KFF Claims Denials and Appeals in ACA Marketplace Plans in 2023
²Based on internal data
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