In an HMO model, what is the role of the assigned primary care physician?

• A. Manages patient care and authorization requests
• B. Provides out-of-network referrals
• C. Does not influence referrals
• D. Acts as a surgeon

Answer: (A)

In an HMO, the assigned primary care physician serves as the gatekeeper who coordinates all your medical care and handles authorization for tests, procedures, and referrals. This means the PCP is your first point of contact, evaluates health concerns, decides when you need specialist input, and requests the necessary approvals so services are covered. This gatekeeping keeps care streamlined, ensures medical necessity, and helps keep costs in check by coordinating in-network care.

The idea that the PCP would routinely provide out-of-network referrals doesn’t fit the HMO model, since coverage is centered on in-network services and referrals come through the PCP. Saying the PCP doesn’t influence referrals contradicts the essential gatekeeper role, and stating that the PCP acts as a surgeon is outside the typical scope of a PCP’s duties.