The choice of where to give birth is one of the most personal decisions expectant parents face. Many individuals assume they must deliver their baby at the hospital where their obstetrician-gynecologist (OB/GYN) primarily practices. This assumption is common because a direct link exists between a doctor’s professional permissions and their ability to care for a patient during labor and delivery. While a strong connection exists, choosing a different hospital is possible, though it involves navigating specific logistical and financial constraints. These factors require proactive investigation to ensure a smooth birthing experience.
Understanding Provider Hospital Privileges
A physician’s ability to admit and treat patients at a hospital is governed by a formal process called “hospital privileges” or “admitting privileges.” This is a rigorous process where a hospital’s governing board and credentialing committee vet the doctor’s qualifications. The process involves verifying the physician’s education, training, state medical license, board certification, and clinical competence before granting them permission to perform specific procedures at the facility.
For an OB/GYN, these privileges must specifically authorize them to manage labor, perform deliveries, and conduct necessary procedures like Cesarean sections at that hospital. Because obtaining and maintaining privileges requires substantial administrative work, most OB/GYNs limit their practice to only one or two primary hospitals. This concentration ensures they can provide continuous care.
The consequence of this system is that if a patient wants their current doctor to attend their birth, the delivery must occur at a hospital where the doctor holds active privileges. A doctor cannot deliver a baby at any hospital the patient chooses; their professional authorization must be established beforehand.
The Logistics of Choosing a Different Hospital
When a patient prefers a hospital other than the one their OB/GYN primarily uses, two logistical scenarios typically emerge. The first, and simplest, is that the patient’s current physician or physician group already holds active admitting privileges at the preferred hospital. In this case, the patient can simply inform their doctor’s office of their preferred delivery location, assuming it is one of the doctor’s affiliated hospitals. This option streamlines the process, as the medical records and care protocols are already established.
The second, more common scenario is that the patient’s current doctor is not affiliated with the desired facility. If the doctor does not have privileges at the patient’s preferred hospital, the patient must choose between prioritizing the physician or the facility. Sticking with the current doctor means delivering at the doctor’s affiliated hospital, even if it was not the patient’s first choice. Conversely, choosing the preferred hospital requires the patient to switch to a new OB/GYN or midwife who holds privileges at that specific facility. This decision is driven entirely by the hospital’s credentialing rules and the doctor’s professional affiliations.
Insurance and Financial Constraints on Hospital Choice
While provider privileges dictate a doctor’s physical access to a hospital, insurance coverage is often the definitive factor that limits a patient’s final choice. Even if a doctor has privileges at a desired hospital, the entire episode of care must be considered “in-network” to avoid substantial financial liability. The distinction between an in-network hospital and an out-of-network hospital can mean the difference between manageable co-pays and astronomical bills. Patients must contact their insurance provider directly to verify that both the hospital facility and the specific physician are covered under their plan.
A common financial pitfall occurs when a patient delivers at an in-network hospital, but one or more of the ancillary providers are out-of-network. These ancillary services often include the anesthesiologist for an epidural, the neonatologist who examines the newborn, or the radiologist who interprets imaging. This could lead to a “surprise bill” where the patient was balance billed for the difference between the out-of-network provider’s charge and the amount their insurance covered. However, the federal No Surprises Act, effective since January 2022, offers protection against most surprise bills for ancillary services provided by out-of-network providers in an in-network hospital setting, limiting the patient’s cost to their in-network rates. It is still advisable to confirm all providers involved in the bundled maternity care are in-network, or at least covered by the Act’s protections, to minimize financial uncertainty.
Changing Providers to Match a Preferred Hospital
If a patient’s preference for a particular hospital—perhaps due to a high-level Neonatal Intensive Care Unit (NICU) or a specific birthing philosophy—outweighs their desire to keep their current doctor, switching providers is the necessary next step. The first action is to research OB/GYNs or midwifery practices that are affiliated with the preferred hospital and, simultaneously, are in-network with the patient’s insurance plan. Finding a practice that satisfies both requirements is the primary filter for making the change.
Once a new provider is selected and has agreed to accept the patient, arrangements must be made to transfer all medical records promptly. This is a time-sensitive process, as the new provider needs the patient’s complete prenatal history, test results, and any existing birth plan to ensure seamless continuity of care. Although a switch can be made at any stage of the pregnancy, it is easier to find a practice willing to accept a transfer earlier rather than later, as some may not accept new patients far into the third trimester. The patient should then schedule their first appointment with the new doctor to establish care well ahead of the anticipated due date.