The sudden onset of labor is a high-stress event, and while most expecting parents plan to deliver at a specific facility, rapid labor may mean the closest hospital is the only option. The distinction between emergency medical treatment and planned obstetric care determines whether you can go to any hospital. The initial moments are governed by federal law, but subsequent financial and logistical details rely on your insurance and established care plan.
Understanding Your Right to Emergency Care
You have a legal right to receive initial emergency care at any hospital that operates an emergency department and accepts Medicare. This protection is mandated by the federal Emergency Medical Treatment and Labor Act (EMTALA). EMTALA requires that any person presenting with an emergency medical condition, including active labor, must receive a medical screening examination to determine if an emergency exists.
If the hospital determines you are in active labor, they must provide stabilizing treatment. For a pregnant individual, stabilization means the woman has delivered the child and the placenta, or a physician certifies that transfer poses no threat to the health or safety of the woman or the unborn child. If delivery is imminent, the hospital must deliver the baby, regardless of your insurance or ability to pay. This right applies even if the facility is out-of-network, but it is limited to the immediate emergency stabilization phase of care.
Financial Implications of Out-of-Network Delivery
While EMTALA ensures you receive necessary emergency stabilization, financial responsibility for the full delivery, hospital stay, and associated services shifts once the emergency is stabilized. If the closest facility is out-of-network, you may face significantly higher out-of-pocket costs, even if the initial emergency treatment was covered. For context, the average total cost for a vaginal delivery is substantial, and costs are amplified at an out-of-network hospital.
You may receive bills from multiple providers who assisted with the birth, such as the anesthesiologist or neonatologist. These specialists may be out-of-network, even if the hospital itself was in-network. The No Surprises Act offers protections against certain surprise medical bills from out-of-network providers for emergency services. For emergency care like active labor, this law generally prohibits providers from billing you more than your in-network cost-sharing amount.
The specific application of the No Surprises Act to all services related to childbirth can be complex, especially with multiple providers like neonatologists who might bill separately. It is important to contact your insurance company as soon as possible after being admitted to an unplanned facility to confirm coverage and understand your financial liability. High deductibles and coinsurance still mean significant out-of-pocket spending, particularly if a neonatal intensive care unit (NICU) stay is required.
Coordinating Care and Post-Stabilization Transfer
If you present to an unplanned hospital and stabilize without immediate delivery, a transfer to your preferred facility may be possible. The treating physician makes the decision, certifying that the benefits of moving outweigh the potential risks to both the mother and the fetus. For a transfer to be considered safe, both the mother’s and the baby’s clinical status must be stable, meaning no material deterioration is likely during transport.
If labor is too far advanced, the clinical team will determine that delivery must happen at the unplanned hospital. In this scenario, the focus shifts to coordinating post-partum care and follow-up with your established obstetrician or midwife. If a subsequent transfer is required, such as for a premature newborn, the hospital must arrange for qualified personnel and specialized transportation equipment.
Communicating with your established care team is highly recommended throughout this process. Your primary OB-GYN or midwife can provide the unplanned hospital with essential medical records and background information. Access to these records, including risk factors or specific birth plans, helps the new medical team provide seamless, informed care.