What is the role of a gatekeeper in an HMO plan?

• A. The gatekeeper coordinates referrals but not care.
• B. The gatekeeper sets provider payment rates.
• C. The gatekeeper is the assigned primary care physician who coordinates care and approves referrals.
• D. The gatekeeper handles member enrollment.

Answer: (C)

In an HMO, the gatekeeper is the assigned primary care physician who coordinates care and approves referrals. This doctor serves as the main point of contact for medical decisions, manages the overall care plan, and determines when a referral to a specialist or additional tests is medically necessary within the plan. This coordination helps control costs and ensure continuity of care within the network. The gatekeeper does not set provider payment rates or handle member enrollment, which are determined by the plan and its administrative processes.