Choosing the location for childbirth is a significant decision, but the logistics of how your healthcare provider and the hospital interact can be confusing. It is a common misperception that an obstetrician or midwife can simply deliver a baby at any hospital of your choosing. The ability to deliver at a different hospital than your doctor currently practices at is governed by medical administration rules, financial insurance policies, and your willingness to change either the doctor or the hospital. Understanding these requirements is the first step in ensuring your preferred birth plan can be executed smoothly.
The Critical Role of Hospital Privileges
A physician is only permitted to admit patients and perform procedures at a hospital where they have been granted clinical privileges. These privileges are formal permissions granted by a hospital’s medical staff and governing board after a rigorous review of a doctor’s credentials, training, and professional history. For an obstetrician, these permissions allow them to manage labor, perform deliveries, and provide necessary surgical care, such as a cesarean section, within that facility.
A doctor must apply for and maintain privileges at each hospital where they intend to deliver. Maintaining these permissions often requires demonstrating a sufficient volume of deliveries and procedures over a two-year period, alongside current certifications. If your current doctor does not possess these privileges at your desired hospital, they cannot attend your delivery there. This makes it an administrative impossibility to use your doctor at that facility.
This administrative barrier exists for liability, credentialing, and patient safety, ensuring that every physician practicing within the hospital is competent. The hospital your current doctor is affiliated with dictates the location of your delivery unless you alter your plan. If you are determined to deliver at a hospital where your doctor lacks privileges, you must either find a new provider who is credentialed there or accept a transfer of care to the on-call hospitalist upon arrival for labor.
Navigating Insurance and Network Coverage
Even if your doctor has the necessary hospital privileges, the primary financial constraint is ensuring both the facility and the associated medical providers are covered by your health insurance network. You must verify that the hospital itself is considered “in-network” to avoid the significantly higher out-of-pocket costs associated with “out-of-network” facility fees. Calling your insurance provider to confirm the hospital’s network status is a fundamental step in planning.
The complexity extends beyond the hospital and the primary obstetrician, involving other providers who may attend your delivery. During labor, you will likely receive care from ancillary service providers. These include anesthesiologists, neonatologists for immediate newborn care, and pathologists for lab work. These providers might belong to a separate group that is considered out-of-network, historically leading to substantial “surprise bills.”
However, the federal No Surprises Act offers protections against this specific scenario, particularly for services received at an in-network hospital. The law bans out-of-network providers, including those who provide ancillary services, from balance billing you for more than your plan’s in-network cost-sharing amount. This means that for emergency or non-emergency services at an in-network facility, you should not be charged more than your typical copay, coinsurance, or deductible.
It is still important to confirm the network status of the hospital and your primary provider, as the law does not eliminate all out-of-network charges for other services. You should contact your insurance plan for a formal estimate of costs, which is often required under the No Surprises Act. This helps you understand your financial obligation for the facility stay, labor room fees, and post-delivery care, including a potential NICU stay.
Options for Changing Your Delivery Plan
If your desired hospital is not where your current doctor delivers, or if you encounter insurance hurdles, there are three main options to consider. The first solution is to find a new obstetrician or midwife who already possesses the necessary privileges at your preferred delivery hospital. You can often call the hospital’s labor and delivery department directly and ask for a list of credentialed providers who deliver there.
Another option is to identify an alternative hospital that is in-network with your insurance and where your current doctor already holds privileges. This choice allows you to maintain your relationship with your established prenatal care team, which can be reassuring, especially late in pregnancy. You should confirm this affiliated hospital’s network status and tour the facility to ensure it meets your expectations for your birth experience.
If your preference is fixed on a particular hospital and you need to switch providers, it is possible to change doctors even in the third trimester. Many medical practices will accept a new patient late in pregnancy, though some may have policies against it, requiring you to explain your circumstances. Once a new provider is chosen, you must submit a written request to your current doctor’s office to transfer all your medical records, including prenatal testing results, to the new practice. This transfer ensures the new team can seamlessly continue your care.