State RegulationsOH specificDifficulty 1/5
In a gatekeeper system used by an HIC, the primary care physician's core role is to:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under the gatekeeper concept associated with the HIC delivery model governed by Ohio Revised Code Chapter 1751, the primary care physician is the member's first point of contact who manages routine care, coordinates treatment, and initiates referrals to specialty physicians when medically appropriate. This structure channels care through the organized delivery system, and the Ohio Department of Insurance supervises HIC operations built on it.
Why the other options are wrong
- A) Primary care physicians coordinate general care; they do not perform every surgical service a member needs.
- B) The gatekeeper directs care before specialist services are received, not merely signs off on claims afterward.
- D) The HIC remains the financing and delivery organization; the primary care physician is a participating provider, not the risk-bearing party.
Memory hook
Gatekeeper PCP: first in the door, coordinator of the whole route.