In an HMO gatekeeper system, if emergency health services are needed, what should Alan do?

• A. Receive permission from the primary physician to begin treatment
• B. Call the HMO to verify coverage
• C. Proceed to the nearest emergency room
• D. Contact the HMO for a listing of approved providers

Answer: (C)

In an HMO with a gatekeeper, routine care is channeled through the primary physician, but emergencies override that process. When emergency health services are needed, the immediate step is to go to the nearest emergency department to get rapid assessment and stabilization.

This approach keeps you safe by ensuring you receive urgent care without delay, regardless of prior authorization. After you’re stabilized, you or the hospital can contact the HMO to coordinate ongoing, in-network care and any post-stabilization requirements.

Visiting the ER first also avoids delays that could occur from trying to obtain permission, verify coverage, or request a provider list in a time-sensitive situation.