Health · Chapter 14 · Managed Care Networks
Primary Care Physician (Gatekeeper)
Definition
The doctor an HMO (or POS) subscriber must select for general care — the PCP controls all referrals to specialists. A PCP referral is a pre-approval; no referral, no in-network specialist coverage.
Exam tip
'Gatekeeper' in a question = HMO or POS plan. PPOs and EPOs need NO referrals.
Easy to confuse with
These are what this term gets tested against — if you can't tell them apart cold, drill the contrast.
Related terms