Gatekeeper

Definition

• Someone who controls access to something. As it relates to health maintenance organizations (HMOs), a gatekeeper is a primary care physician (PCP) who directs the insured's access to medical services. Aside for medical emergencies, the insured person must first seek acceptance from their gatekeeper before receiving medical care.

Synonyms
supervisor, caretaker

Alternate Spellings
gate keeper

Related Terms and Acronyms

• Case Management — Definition,
  • A system where medical services and patient treatments are coordinated by a case manager.
• Health Maintenance Organization (HMO) — Acronym, Important,
  • A healthcare plan where insured people receive reasonably priced health insurance through an organization with firm guidelines on the scope of care.
• Healthcare Plan — Definition,
  • Insurance that can cover medical and dental expenses for insured people.
• Least Expensive Alternative Treatment (LEAT) — Acronym,
  • When multiple treatment options exist for the same illness, insurers are only obligated to provide the most cost effective treatment.
• Point of Service Plan — Definition,
  • A health insurance plan that combines the features of both health maintenance organizations and preferred provider organizations.
• Preferred Provider Organization (PPO) — Acronym,
  • A health care program that gives its members a level of freedom and independence when choosing health care options.
• Primary Care Physician — Definition,
  • A doctor who administers or arranges the majority of an individual's health care needs.
• Usual, Customary and Reasonable Fees — Definition,
  • The expected cost of a medical treatment, and what an insurance company is willing to pay.