In Health Maintenance Organizations (HMOs), thegatekeeper strategyinvolves a primary care physician (PCP) who coordinates patient care and provides referrals to specialists. This ensures that care is managed efficiently and only necessary specialist visits are authorized, aligning with the HMO’s cost-containment model.
Option A: Incorrect. Refusing coverage for preexisting conditions is unrelated to the gatekeeper role and is regulated by HIPAA, not HMO strategy.
Option B: Correct. The gatekeeper strategy requires referrals from a PCP to see specialists, a hallmark of HMO plans.
Option C: Incorrect. HMOs encourage preventive care, not preventing service use, to manage costs.
Option D: Incorrect. Supplemental services at additional cost are not part of the gatekeeper strategy.
This question falls under the Prometric content outline section on “Health Providers and Products,” which covers HMO structures and strategies.
[:, Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: General Knowledge – Health Providers and Products)., Oklahoma Insurance Department, Title 36 O.S. § 652 et seq. (managed care regulations)., Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing., ]
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