What is meant by the term “gatekeeper system”?
  1. Members must get authorizations from primary care providers
  2. HMO determines the need of care
  3. Access to providers is limited
  4. Referrals are available only during regular business hours
Explanation
Answer: A - The “gatekeeper system” means that members must get authorizations from primary care providers. Members select their primary care providers, and when they require services outside of this provider, the primary care provider must authorize the referral. In the event of an emergency situation, the members’ needs would be covered but the primary care provider should be notified as soon as possible.
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