Over the past year, something important has started to shift in healthcare: prior authorization, one of the most frustrating parts of the system for patients and doctors, is finally getting easier. Health plans across the country, including Florida Blue, have taken measurable steps to simplify the process, reduce unnecessary requirements, and speed up approvals.

We know prior authorization has long felt confusing, slow, and sometimes like a barrier to care. You’re not imagining it. The process hasn’t always worked the way people need it to. That’s why these improvements matter and why we’re committed to continuing this work until the experience feels clearer, faster, and more predictable for everyone.

What Prior Authorization Is — and Why It Exists

Prior authorization is when a doctor asks a health plan to confirm coverage before a treatment, test, or medication is given. It’s different from a claim, which is a request for payment after care is delivered.

Think of it this way:

• Prior authorization = “Can this treatment be approved?”
• Claim = “Here’s the bill for the treatment.”

Despite how it may feel, most care does not require prior authorization. In fact, at Florida Blue, 96% of prescriptions and 93% of medical services are not impacted by prior authorization.

For the small percentage that do, prior authorization serves as a safeguard to ensure care is safe, effective, supported by clinical evidence, covered by the member’s plan, and as affordable as possible.

Delays sometimes happen when information that’s initially submitted is incomplete or incorrect, and additional details are needed to verify the care aligns with evidence-based medicine. When this happens, providers submit the necessary details so an informed decision can be made.

Why People Are Frustrated — and Why We Understand

Across the country, patients and providers describe prior authorization as:

• A barrier or delay to care
• A process that can feel like “fighting” for treatment
• Something that second-guesses clinicians
• A system that changes too slowly

We hear this. We understand it and agree that the process must be better.

That’s why Florida Blue and our parent company, GuideWell, have been working for years to modernize prior authorization, and why we joined a national, multiyear commitment in 2025 to simplify and streamline the process across the entire healthcare system.

What’s New in 2026: Meaningful Progress You Can Feel

The past year brought meaningful improvements across the industry. Here are the most important developments shaping the future of prior authorization:

A Standardized, Electronic Prior Authorization Process

Florida Blue and other leading health plans have adopted a standardized electronic process for the majority of medical services that commonly require prior authorization, including orthopedic surgeries and imaging services like CT scans and MRIs.

This milestone means:

• A single, consistent way for providers to submit requests
• Faster answers for patients
• Less friction and fewer administrative burdens
• A more predictable experience for doctors

Additional services will be added over time, and health plans will continue adopting these standards beginning January 1, 2027.

Fewer Prior Authorizations Overall

In early 2026, health plans announced measurable progress on the commitments made over the course of several months:

• 11% reduction in prior authorization volume
• 6.5 million fewer prior authorizations for patients nationwide
• Improved continuity of care, meaning members who switch insurance can keep their existing prior authorization approvals
• Clearer communication on decisions and next steps

This eases administrative burdens and helps patients access evidence-based care more quickly.

RealTime Answers at the Point of Care

Florida Blue has made significant progress: 87% of prior authorization decisions now happen in real time while patients are still in the doctor’s office. To achieve even better results, both plans and providers must move away from manual processes and adopt instant electronic data sharing — investments Florida Blue started making years ago and continues to expand.

Florida Blue’s Approach: Faster, Simpler, More Transparent

Florida Blue began modernizing prior authorization long before the 2025 industry pledge, and we’re accelerating that work.

1. Using technology to speed up approvals: Since 2022, Florida Blue has processed over 2.5 million prior authorization requests with a median response time of 19 seconds. It’s important to know that AI is only used at Florida Blue to approve — never deny — a prior authorization request: If AI cannot approve a request, it goes to a trained medical or pharmacy specialist for review.
2. Reducing the number of services that require prior authorization: We regularly review and remove requirements for services that are almost always approved. More reductions are planned through 2027.
3. Protecting continuity of care: If a member switches insurance during treatment, most health plans will honor an existing prior authorization for 90 days. This prevents disruptions in care.
4. Providing clearer explanations: If a request is denied, we provide a clear explanation and information on how to appeal. Members may also request a federal external review in certain cases.
5. Ensuring medical professionals review medical denials: Any denial based on medical necessity is reviewed by a clinician — this has long been our standard practice.

What This Means for You

These changes are designed to make prior authorization:

• Faster — more realtime decisions
• Simpler — fewer services requiring prior authorization
• More consistent — standardized electronic submissions
• More transparent — clearer communication and easier appeals
• Less disruptive — continuity of care when switching plans

Our goal is to make the process feel less like a barrier and more like what it was meant to be: a safeguard that helps ensure safe, effective, evidencebased care.

Looking Ahead

Florida Blue and GuideWell are committed to driving meaningful change in healthcare. We know the system is complex, and we know prior authorization has not always worked the way people need it to. But the progress is significant, and we’re not stopping.

We’ll continue collaborating with industry partners, clinicians, and federal agencies to reduce unnecessary prior authorizations, expand realtime electronic decisioning, improve transparency, support safe ad evidencebased care, and make healthcare easier to navigate. When the process works better, people get the care they need faster and we’re saving them money along the way. That’s what matters most.

Michael Lawrence, APR | Senior Regional Communications Lead (Central FL)

Michael.Lawrence@floridablue.com | (407) 257-8160 (C)
610 Crescent Executive Ct., Suite 600, Lake Mary, FL 32746

Sources

¹Based on a 2024 survey of AHIP’s Commercial health plan members.

²AHIP. (2025, June 23). Health Plans Take Action to Simplify Prior Authorization. [Press release].

*Based on internal data
A prior authorization is not a guarantee of payment. Deductibles, coinsurance, and copays may still be applicable.