CandleFocus Glossary Editor
Gatekeepers play an important role in both health insurance plans and long-term care plans. In health insurance, gatekeepers oversee patient treatment and are an integral part of what is known as “managed care”. A Gatekeeper is the primary care physician, nurse practitioner, or physician’s assistant who serves as the first line of contact when a patient needs medical care. The goal of having a Gatekeeper as part of a health insurance plan is to ensure that the patient receives appropriate and cost-effective treatment.
The Gatekeeper model of health care establishes a relationship between the patient and the primary care provider, who becomes the patient’s personal physician. The Gatekeeper must have an understanding of the patient and can offer a comprehensive approach to medical decision-making that evaluates the patient’s overall medical needs. The Gatekeeper is responsible for assessing the patient and their medical condition, determining the best course of treatment, and managing the health care budget so that both the patient and insurance company get maximum value for the money spent on healthcare. The Gatekeeper also acts as a patient advocate and advisor, ensuring that the patient is provided with appropriate treatment, services and tests.
In long-term care plans, Gatekeepers are an important part of the eligibility requirements. In order to collect on a long-term care insurance plan, the insured needs to demonstrate “catastrophic impairments”, such as those required for Social Security Disability. These impairments qualify the insured for long-term care services, and must be assessed and documented by a Gatekeeper who is employed specifically for this purpose. The Gatekeeper must meet the qualifications required to assess the patient’s condition, conclusively rule out alternative diagnoses, and document the eligibility of the long-term care insurance policy.
Gatekeepers are an essential part of both health insurance and long-term care plans. In health insurance, Gatekeepers ensure that patients receive proper care, while in long-term care, Gatekeepers are necessary to determine the patient’s eligibility for payouts. By taking on the roles of patient advocate, medical decision maker and budget manager, Gatekeepers have a major impact on the well-being of their patients and the successful implementation of medical insurance plans.
The Gatekeeper model of health care establishes a relationship between the patient and the primary care provider, who becomes the patient’s personal physician. The Gatekeeper must have an understanding of the patient and can offer a comprehensive approach to medical decision-making that evaluates the patient’s overall medical needs. The Gatekeeper is responsible for assessing the patient and their medical condition, determining the best course of treatment, and managing the health care budget so that both the patient and insurance company get maximum value for the money spent on healthcare. The Gatekeeper also acts as a patient advocate and advisor, ensuring that the patient is provided with appropriate treatment, services and tests.
In long-term care plans, Gatekeepers are an important part of the eligibility requirements. In order to collect on a long-term care insurance plan, the insured needs to demonstrate “catastrophic impairments”, such as those required for Social Security Disability. These impairments qualify the insured for long-term care services, and must be assessed and documented by a Gatekeeper who is employed specifically for this purpose. The Gatekeeper must meet the qualifications required to assess the patient’s condition, conclusively rule out alternative diagnoses, and document the eligibility of the long-term care insurance policy.
Gatekeepers are an essential part of both health insurance and long-term care plans. In health insurance, Gatekeepers ensure that patients receive proper care, while in long-term care, Gatekeepers are necessary to determine the patient’s eligibility for payouts. By taking on the roles of patient advocate, medical decision maker and budget manager, Gatekeepers have a major impact on the well-being of their patients and the successful implementation of medical insurance plans.