Insurance Glossary

Insurance Term - Gatekeeper (Primary Care Physician)

Under some health insurance arrangements, a gatekeeper is responsible for the administration of the patient’s treatment; the gatekeeper coordinates and authorizes all medical services, laboratory studies, specialty referrals and hospitalizations. A primary care physician in a managed care environment is responsible for managing the patient’s overall care and who must authorize all specialist referrals. In most health maintenance organizations (HMOs), secondary care is not covered by insurance, if the primary care physician does not approve it.

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