Claims and Health Statements FAQs

• Where can I go to get information about a claim?

  You can log in to your member account at FloridaBlue.com or call the Customer Service number on your member ID card.

• When I receive services outside the State of Florida, who submits the claim to Florida Blue?

  When you’re in the United States and choose doctors or hospitals that participate in our BlueCard program, the health care provider will submit claims on your behalf. When you visit a non-participating provider throughout the U.S.and providers outside the U.S., you may be responsible for filing your claims.
  Non-participating provider claim form
  Outside the U.S. claim form
  To locate a provider outside of Florida or the U.S., visit bcbs.com or call 1-800-810-BLUE (2583).

  For more information, BlueOptions and BlueChoice members please refer to our BlueCard brochure. BlueCare (HMO) members, please refer to our Away from Home Care brochure.

• What if I have a question about a claim?

  If you are logged in to your member account at FloridaBlue.com you can email us a question. Or you can call the Customer Service number on your member ID card.

• What are my Privacy Rights?

  View information about your Privacy Act Rights.

• Do I have to submit claims?

  Not if you choose a provider from within your plan provider network. Your provider should process all claim submission paperwork on your behalf. If you choose a provider outside the network, you may have to file claims for reimbursement.

• What is a Member Health statement?

  A Member Health Statement is a summary of finalized health and pharmacy claims for the prior month. This statement shows how claims were paid and what amounts you may be responsible for paying. You’ll also find helpful tips for maximizing your benefits and taking care of your health.

• Where can I find my Member Health statement online?

  To see your Health Statement and all of your claims, log in to your online account and view Claims & Expenses. Your statements are always available online where you can view, sort and print your information, if desired. You can also receive a statement in the mail if you log in and choose paper instead of online statements.

• What are medical coverage guidelines?

  Florida Blue strives to cover procedures, treatments, devices and drugs that are proven to be safe and effective for a particular disease or condition. Our Medical Coverage Guidelines include criteria used in determining coverage for payment purposes.