Florida Blue MA

Contract: H5350 · Plan type: HMO

Evidence lead: Ranks four through six · Large request-volume cohort

Florida Blue MA: One of the ten largest authorization workloads

The 420,000 recorded requests place this contract in the highest-volume tier. Its request-volume rank is #6 of 37. Volume shows the denominator behind approvals and denials; it is not a measure of plan quality, membership, benefit breadth, price, or future coverage decisions.

Ranks four through six · Large request-volume cohort

One of the ten largest authorization workloads

The 420,000 recorded requests place this contract in the highest-volume tier. Its request-volume rank is #6 of 37. Volume shows the denominator behind approvals and denials; it is not a measure of plan quality, membership, benefit breadth, price, or future coverage decisions.

Ranks seven through ten · Higher denial-rate cohort

A top-ten denial rate in this source set

Florida Blue MA's 9.6% denial rate is in the highest group of the comparison. The exact rank is #9 of 37. This is aggregate prior-authorization activity for the reporting window, not a probability that a particular service, drug, or beneficiary request will be denied.

Ranks twenty-six through thirty · Lower-middle reversal reach

Reversals covered a below-median share of denials

The 3,992 recorded reversals amount to 9.9% of this contract's denied requests. The cross-contract rank is #28 of 37. This derived measure combines appeal filing and outcome, so it supplies scale context but does not identify clinical reasons, administrative errors, or coverage rules.

Ranks eleven through fifteen · Upper-middle appeal uptake

Appeal filing exceeded most contract records

The 6,048 filed appeals represent 15.0% of denied requests. That is rank #11 of 37 for filing share. The ratio reports aggregate activity; it cannot reveal why an appeal was or was not filed, whether the underlying cases were comparable, or what happened outside the reporting window.

Ranks twenty-six through thirty · Lower-middle overturn cohort

Appeal overturns sat below the table midpoint

This contract records a 66.0% overturn rate among filed appeals. Its overturn-rate rank is #27 of 37. The denominator is filed appeals, not all authorization requests. The percentage therefore describes reviewed appeals and must not be read as an individual outcome forecast.

Prior Authorization Scorecard

PA Requests
420,000
PA Denial Rate
9.6%
Appeals Filed
6,048
Appeal Overturn Rate
66.0%

Detailed Metrics

Metric Value
Prior Authorization Requests 420,000
PA Approved 379,680
PA Denied 40,320
Appeals Filed 6,048
Appeals Overturned 3,992
Source: CMS Office of Inspector General report OEI-09-22-00380; KFF 2023 Medicare Advantage analysis. Verify with HHS OIG → · CMS.gov →
Sources, caveats, and related notes for Florida Blue MA
What does Florida Blue MA's overturn rate mean? Of the appeals filed after denials in this source record, 66% were overturned (3,992 of 6,048 filed appeals, not all 40,320 denied requests).
This data is for informational purposes only and does not constitute medical, financial, or insurance advice. Contact CMS or your plan for coverage decisions. Data from CMS OIG and KFF Medicare Advantage analysis.

Data: CMS OIG OEI-09-22-00380 and KFF 2023 Medicare Advantage analysis. Not affiliated with CMS. ← All MA plans

Read our methodology - how this data is sourced, computed, and verified.

Primary data: U.S. Department of Health & Human Services, Office of Inspector General, Medicare Advantage Encounter Data (Report OEI-09-22-00380, 2024). Secondary data: Kaiser Family Foundation 2023 Medicare Advantage Prior Authorization analysis. Methodology and editorial review by PlainInsurer, see methodology.