HMO Referral Terminology:

Gatekeeper — Some HMOs consider the primary care physician to be the "gatekeeper" who serves as the patient’s initial contact and approval point for medical care and referrals.

HMO — A health insurance plan that is a Health Maintenance Organization (HMO) and is often called a managed care plan. These health plans take steps to monitor and manage medical services received by members.

Primary Care Physician (PCP) — The physician who provides routine or general medical care. This is typically a general internist, pediatrician or OB/GYN physician. The terms general, regular or family doctor also describe a PCP.

Referral — The recommendation by a doctor for a patient to receive care from a different physician. For example, a primary care physician may refer a patient with a heart problem to a cardiologist. Some HMOs require that referral be made using a referral form. Other plans may ask the doctor to submit the referral to the HMO by phone.