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Gatekeeper - Health Insurance Definition

The Gatekeeper is the person who coordinates your care when you carry a managed care plan. Your gatekeeper will most often by your personal physician but the duties could also be filled by a person hired by the insurance company. The gatekeepers duties are to be the first person of contact for questions about your health care needs. That person also approves referrals to specialists.

Before you decide that you don’t want anyone making those decisions and having that kind of power over you, consider this: If your primary physician told you that you should see Dr. X for a particular complaint, would you follow that advice? If you already trust your doctor to make the right suggestions, it’s a small step to trusting him or her to be your gatekeeper.

But before you decide that having a gatekeeper is acceptable, consider that you may not always have control over the person who serves as gatekeeper. Within a managed care plan, you are subject to the rules of the company providing the service.
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