1) User's browser requests page from Site A
2) Page from Site A suggests what should be sent in the referrer via the meta referrer
3) User clicks on link from Site A to Site B
4) User's browser requests page from Site B (referrer is set by either user's overriding option or the meta referrer from Site A)
So indeed, at no point does Site A speak to Site B directly. The meta referrer simply asks the user to either send or not send the referrer. If the meta referrer is not present or not supported, it falls back to default HTTP Referrer behaviour.
As the user, you can override this behaviour and force the referrer to do whatever you'd like. This includes refusing to send it, always sending it, or spoofing it. Firefox for example allows you to set network.http.sendRefererHeader and there are various browser extensions for any popular browser that will allow for finer grained referrer control.