Asked by: Dochia Uggias
asked in category: General Last Updated: 2nd January, 2020

Is Point of Service a gatekeeper?

Gatekeeper – refers to the requirement that an HMO ( Health Maintenance Organization) or a POS (Point of Service ) plan participant must have their health care coordinated by their PCP (Primary Care Physician). There are two notable exceptions to this requirement; OB-GYN exams and routine Eye Exams.

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Similarly, is Point of Service a gatekeeper or open access?

Open-access and point-of-service (POS) products are a combination of an HMO and traditional indemnity plan. The member(s) are not required to use a gatekeeper or obtain a referral before seeing a specialist. In that case, the traditional benefits are applicable.

Similarly, what does point of service insurance mean? A point of service plan is a type of managed care health insurance plan in the United States. It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice.

Accordingly, what is the purpose of a gatekeeper in healthcare?

Anyone who receives health insurance coverage in the form of a managed care plan, specifically a health maintenance organization (HMO) plan, is assigned a gatekeeper or allowed to choose one. This means the gatekeeper is in charge of authorizing the patient's referrals, hospitalizations, and lab studies.

What is meant by the gatekeeper requirements?

A gatekeeper refers to requirements that must be met before an individual can qualify for a long-term care plan or to an individual who oversees a patient treatment through a health maintenance organization, or HMO.

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