Which of these will typically authorize treatment from a specialist?

• A. Case manager
• B. Gatekeeper
• C. Preferred provider organization
• D. Exclusive provider organization

Answer: (B)

Gatekeeping in managed care is the process that controls access to specialist care. The gatekeeper, usually the primary care physician, must review and authorize a referral before a patient can see a specialist. This ensures the specialist visit is medically necessary, coordinated with the overall treatment plan, and helps manage costs by preventing unnecessary referrals. A case manager may coordinate care across services, but the authority to approve a specialist referral typically rests with the gatekeeper. PPOs and EPOs differ: PPOs generally let patients see specialists without a referral, while EPOs limit coverage to in-network providers; neither relies on a gatekeeper routinely authorizing specialist care.