In an HMO, who acts as gatekeeper to authorize access to specialists?

• A. Insurance adjuster
• B. Primary Care Physician
• C. Pharmacist
• D. Patient

Answer: (B)

In an HMO, the primary care physician acts as the gatekeeper for specialist access. The PCP is the first point of contact who evaluates your condition, coordinates your overall care, and decides whether a referral to a specialist is needed. This referral process helps ensure that specialist visits are medically necessary and that care stays coordinated and cost-effective. The other roles don’t perform this clinical authorization: an insurance adjuster handles claims, not care decisions; a pharmacist focuses on medications; and a patient typically cannot self-refer to a specialist within a standard HMO plan, except in emergencies.