What is a gatekeeper?

By Chizoba Morah AAA

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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.


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