What is a gatekeeper?

By Chizoba Morah AAA
A:

A g



atekeeper is a health insurance term used to describe the person in charge of a patient's treatment. Anyone who receives health insurance coverage in the form of a managed care plan, specifically a Health Maintenance Organization (HMO) plan, is assigned a gatekeeper or allowed to choose one. In some cases, the insured party is instructed to choose a primary care physician from a list, and that doctor becomes the gatekeeper for that patient.



A gatekeeper's duty primarily is to manage a patient's treatment. This means that the gatekeeper is in charge of authorizing the patient's referrals, hospitalizations and lab studies. When a patient falls ill or needs to be referred to a specialist, the patient contacts the gatekeeper who, in turn, refers the patient to doctors and specialists within the plan network.



To learn more about managed care plans (PPO and HMO), read How to Choose a Healthcare Plan.



RELATED FAQS

  1. What are the tax implications of a life insurance policy loan?

    Learn the instances in which you are required to pay taxes on a life insurance policy loan, so you can avoid making a costly ...
  2. What is a collateral assignment of life insurance?

    Learn about collateral assignment of life insurance so you can make a wise decision about what kind of collateral to use ...
  3. What's the difference between a grace period and a run out period?

    Find out what a health flexible spending account is and what a grace period and run-out period are and why they are so important ...
  4. How does the grace period work on my Flexible Spending Account (FSA)?

    Learn how the grace period works on a flexible spending account so you can take full advantage of your annual pretax contributions.
RELATED TERMS
  1. Disease Management Program

    Disease management programs can help control health care expenses ...
  2. Re-Entry Term Insurance

    A type of term life insurance contract that offers low rates ...
  3. Hazardous Activity

    If one of your hobbies falls under an insurance company’s definition ...
  4. Out-of-Pocket Limit

    Out of Pocket Limit
  5. Surrender Period

    The amount of time an investor must wait until he or she can ...
  6. Least Expensive Alternative Treatment (LEAT)

    A clause in an insurance policy that indicates that the insurer ...
Related Articles
  1. Health Open Enrollment: Read This Before ...
    Insurance

    Health Open Enrollment: Read This Before ...

  2. 5 Ways To Ace 2015's Health Insurance ...
    Insurance

    5 Ways To Ace 2015's Health Insurance ...

  3. 'Donut Hole' Essentials For The Financial ...
    Investing Basics

    'Donut Hole' Essentials For The Financial ...

  4. Is Burial Insurance A Ripoff?
    Insurance

    Is Burial Insurance A Ripoff?

  5. An Introduction To Price Action Trading ...
    Trading Strategies

    An Introduction To Price Action Trading ...

Trading Center