Why I Charge for Late Cancellations and No-Shows to Therapy

Person works at business desk with alarm clock in sharp focus in foregroundWhile recently updating our business practices, my colleague and I had a lengthy conversation regarding cancellation and no-show policies and related fees. I became curious how others, both clinicians and those seeking therapy, feel about this sometimes seemingly taboo topic.

Let me first state my practice’s policy: We request 24 hours’ notice for cancellations. Cancellations made prior to this window are rescheduled with no penalty. Cancellations made without 24 hours’ notice but prior to the start of the session incur a $50 late-cancellation fee. No-shows or cancellations made after the start of the session incur the full fee.

I’m curious what people’s reactions to this policy are. My guess is some may find it too harsh, while others may find it too lenient or too complicated. Many mental health care practitioners’ policies include charging the full fee for any cancellation within a 24- to 48-hour requested window of notice.

For a long time, I had a hard time justifying collecting money, especially the full fee, for what ultimately amounted to me ending up with “free” time. But as I gained experience, missed appointments added up to a significant loss of income, and I came to recognize that the potential for frustration and resentment was not healthy for the therapeutic relationship.

Knowing I needed to find an effective and fair solution, I decided upon the above policy. My rationale included several factors, the first involving the recognition that the people who choose to work with me are ultimately paying for my time. In general, individuals in therapy tend to come to weekly or, sometimes, every-other-week sessions. Their session time is carved out in my calendar and set aside just for them. If somebody cancels with some notice, I know I have an open hour. I can schedule another appointment, run out and do an errand, or peacefully return calls without watching for a potential latecomer. I have had a hard time charging people a full fee in this situation. The $50 fee for less than 24 hours’ notice, however, feels like a fair compromise. It’s like collecting a deposit to have held the session time.

On the other hand, if someone doesn’t show up at all or communicates a cancellation after the start of the session time, I’m stuck waiting to see if they are running late. At about a quarter after, I spend time trying to get in touch to follow up and reschedule. It doesn’t leave me the freedom to be truly productive with the time and minutes left until my next appointment. Thus, I’m better able to justify collecting a full fee in these instances.

I understand stuff happens—projects at work pop up, kids get sick, tires go flat. Most people respect the policy after a gentle reminder and tend not to have frequent last-minute conflicts or cancellations arise. However, I found that routinely not charging for late cancellations sets a precedent some people end up taking advantage of, and I’ve noticed a trend where the people who cancel late or no-show tend to be chronic offenders.

I understand stuff happens—projects at work pop up, kids get sick, tires go flat. Most people respect the policy after a gentle reminder and tend not to have frequent last-minute conflicts or cancellations arise. However, I found that routinely not charging for late cancellations sets a precedent some people end up taking advantage of, and I’ve noticed a trend where the people who cancel late or no-show tend to be chronic offenders.

The more I contemplated whether it is fair to charge a late-cancellation fee, the more I came to understand that implementing some penalty for late cancellations and no-shows is an important part of the broader scope of the therapeutic work. People seek therapy to improve their overall quality of life, and those who frequently cancel or fail to show up for appointments often demonstrate issues with commitment, accountability, and responsibility in other areas of their lives. I ultimately realized I am doing the people I work with a disservice if I enable them to avoid facing responsibility, and that I am failing to help them develop an understanding that the real world has consequences to various choices and actions.

Instead, I want to model healthy and clear boundaries and empower people to be responsible in their lives and assertive in their ability to communicate regarding their circumstances. Therapy is about helping people to develop a sense of awareness about themselves and how their actions impact those around them.

Therapy tends to be most helpful to people who view their appointments as an important and valuable component of their lives. And for most people, money equals value. When people are willing to make therapy a priority and accept the financial commitment involved, they tend to experience greater and quicker growth and positive change.

Discussion regarding money can be an uncomfortable topic, especially in a therapeutic relationship where connection, support, and compassion are paramount. The collection of money for services—rendered or not—sometimes feels contradictory to the nature of the work, and it is often difficult to navigate the line between the professional and truly caring ends of the relationship. But the handling of and attitude toward these finer details of business are important to the process and worth consideration for all involved. Being confident in and mindful of boundaries and policies, paired with the ability to broach uncomfortable topics, is often where true trust, authenticity, and connection develops—and these are the components that make therapy genuinely helpful.

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Megan MacCutcheon, LPC, therapist in Vienna, Virginia

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Cora

    Cora

    September 21st, 2016 at 7:08 AM

    Well why not?
    Your time is money, same as hair dressers and anyone who works on an appointment basis

  • Claire

    Claire

    September 21st, 2016 at 10:07 AM

    I too will charge for missed appointments, but typically not full price and only those who are repeat offenders.

  • ben

    ben

    September 21st, 2016 at 2:12 PM

    Well I am not for this at all! I think there are times when you legitimately have to cancel and sometimes that cannot be within that magic 24 hour window. I would probably end up going to someone else if they charged me like that.
    Ok so I can see it for someone who is a habitual offender but one or two time? Not cool.

  • Bill H

    Bill H

    September 22nd, 2016 at 7:18 PM

    Most therapists, unlike MDs or dentists, make allowances in cases of real emergencies. Even missing once or twice without giving notice is an indication of something that needs to be addressed in the relationship between therapist and client. By not giving proper notice, you are essentially stealing an hour of the clinician’s time. That’s really not cool, unless there’s a significantly important reason for doing so.

  • Harold S.

    Harold S.

    September 23rd, 2016 at 5:25 PM

    If you buy tickets to a concert, and are unable to attend for any reason, the concert venue does not provide a refund. There are those patients that have genuine emergencies. And there are those who do not respect therapy and are continually late, and make excuses for being late. If someone no-shows, the therapist is out time and money. Another patient could have been scheduled. I am changing my policy to first short notice cancellation, things slide, and then after that, a strict policy of full session fee for cancellation within 24 no matter the reason.

  • Mike

    Mike

    September 23rd, 2016 at 8:19 PM

    My therapist has a cancellation fee, but has always waived it when I’ve been sick, and even better he tries to work me in over the next couple of days so I don’t miss a whole week and he still gets his income (win-win). I feel that it’s necessary to set boundaries and have consequences, otherwise the therapist is not helping me to better meet life challenges outside the session. If the therapist clearly conveys caring and empathy, I think most clients can see that he has their best interest in mind. A therapist is not supposed to hold your hand and say lovely things all the time. But of course, my opinion is that a therapist can convey unconditional care and positive regard through it all. And not every client is ready to be thrown out of the nest. Early in therapy, he extended himself a little more and gave me a little more freedom without consequences, which I think was appropriate, but he doesn’t treat me with kid gloves any more.

  • Annetta

    Annetta

    September 22nd, 2016 at 8:01 AM

    I guess you have to look at it as they are not making any money for the day when patients constantly pull a no show on them. That is not fair to anyone. If you go to work to do your job and you are there then you expect that you will be paid. People cancel at the last minute or even worse don’t show up, then how are they supposed to make a living and recoup some of those lost charges? I say yes, if you are fair and thoughtful about it, then I see nothing wrong with it.

  • Jennifer

    Jennifer

    May 17th, 2018 at 4:08 AM

    How are they supposed to make a living? Er, by you rescheduling for another time. Are you saying that every single therapist is booked up eternally? NO. They have revolving clients and the best way to recoup your missed appointment is to replace it with an alternate time, no loss to the therapist. It’s not like a hotel that can only be charged at a specific time and date, and this is a genuine loss for a no show. But as a patient, I am not essentially a ‘no show’ if I reschedule my missed appointment. It’s not a ‘missed’ appointment, it’s a moved appointment. Any patient who wanted that time, would have found an alternative too. It could only be a missed or lost ‘patient’ and its very unlikely that a therapist would really lose a patient just because they can only book times that are currently available.

  • Jennie, LMT

    Jennie, LMT

    August 7th, 2018 at 8:12 AM

    Sometimes a reschedule can be a loss to the therapist if they count on that $ that particular $ that week.

  • Sal

    Sal

    November 17th, 2018 at 9:20 PM

    Yesterday I had 4 clients who did not show up (either with less than 24 hours notice, and one just did not arrive). I still have to pay rent for the room. I drive nearly 2 hours to this rural practice once per week (and pay to stay the night). I did not receive any income, and it cost me both money AND time away from my 4 children and husband. I have not been enforcing my cancellation policy (as I am aware that these people are low-income earners), but I am now changing my practice. My business cannot sustain no-shows…

  • Maura

    Maura

    September 22nd, 2016 at 10:50 AM

    I think that it is the rudest thing ever to have an appointment somewhere and then not even take the common courtesy to cancel the appointment if you are not going to show up.
    We have no shows in our office all the time and then people wonder why we sometimes double book. It is because there is still a large majority of people who will make an appointment and then not bother to show up.
    What are we supposed to do, twiddle our thumbs and still hope that magically the money will be generated to pay us?
    Nope you sort of beef up the schedule a little bit and then when everyone shows up you just sort of bust your tail that day to have them all seen.

  • Karen

    Karen

    September 22nd, 2016 at 11:43 AM

    This is a tough subject because therapy is a very vulnerable process. I have been in therapy for 9 years now, and I have yet to call in once or show up late.. not one session have I missed .. but if for some reason I didn’t show up and didn’t give notice, I would take offend to being charged because its not like me to not show up. I would have to say that, the best way to handle this is maybe to look at it as a person by person situation. I would charge only those who make this a habit or take this time for granted.. but for someone like me, or someone who is really dedicated to the process, I would really be more curious about it and talk to the client about it. I think its harsh to penalize a while session price especially if the person is not one to call out or be late.

  • Megan MacCutcheon, LPC

    Megan MacCutcheon, LPC

    October 1st, 2016 at 6:09 AM

    I totally agree with you, Karen, that it ultimately is enforced on a case-by-case basis. If somebody with a history of being incredibly reliable doesn’t show up once, I would definitely be worried and of course would cut that person some slack. You can definitely stray from the policies and make exceptions as necessary – the hard part is coming up with a policy that will be fair and comprehensive in order to have clear and consistent expectations up front. The opposite of that is making up the rules as you go, which isn’t fair. But yes, there will definitely be times where exceptions are made!

  • Radonna N

    Radonna N

    September 22nd, 2016 at 12:47 PM

    I can’t imagine not showing up. I have never even been late. I didn’t see how you cover illness but even when I’m sick I FaceTime my therapist. My time with her is not replaceable and I would never want her to give away my appt slit or replace me so I respect her. I can see how your time is money but I can’t imagine not showing up.

  • Kathleen

    Kathleen

    September 22nd, 2016 at 6:15 PM

    It’s not legal in my state to charge a Medicaid patient a fee for a missed appointment for any reason. Many private insurance companies do not allow for this either. It’s really only in a cash pay situation that a therapist can do this.

  • Danielle

    Danielle

    September 23rd, 2016 at 8:46 AM

    How does this work with clients on public medical insurance (Medical Assistance, MNSure, Medicare…)? Are clinicians allowed to charge those individuals?

  • Harold S.

    Harold S.

    September 23rd, 2016 at 5:28 PM

    A therapist may not be able to charge a Medicare patient for a missed session, but the therapist can discuss the issue of missed sessions and short notice cancellations and make that part of therapy.

  • Sher

    Sher

    August 26th, 2017 at 11:01 AM

    I am an in-house biller for a psychology & therapy clinic and you may not charge a medicaid patient missed appointment or no-show fee. However, you CAN charge a Medicare patient a fee. cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM5613.pdf

    We’re implementing a cancellation policy due to chronic no-shows & last minute cancellations. Some patients are medicaid so we’re discussing limiting no-shows/last minutes to a certain amount and then they’ll have to find another place. It’s a matter of holding people accountable and respecting the service we’re providing. We’ve had so many days where a therapist is booked from 8am – 5pm on a Saturday and the first and last appointments show but all the ones in between late cancel or no-show. So the therapist has to sit there all day just for the last appointment. It’s incredibly disrespectful. When there are no consequences, the negative behavior continues…thus the pattern doesn’t cease. This is a business and yes we provide a much needed service but we have bills to pay, payroll, taxes, etc and we can’t do that when we don’t have enough time to fill an appointment without enough notice.

  • Teri

    Teri

    September 23rd, 2016 at 10:21 AM

    but you can refuse to see them again if this is a pattern of behavior.
    that is your prerogative correct?

  • Lauri

    Lauri

    September 23rd, 2016 at 10:11 PM

    My therapist has this policy-one with which I agree-and he also applies something similar in the reverse. If he misses a session because he made an error with scheduling, he will reschedule me ASAP and will not charge for the rescheduled session, because it was his error, and it inconvenienved me. He does other things like that so that the policy os applied both ways. This shows respect for both the therapist’s AND the client’s time.

    However, regardless of his practice applying this policy in reverse, I would still feel obligated to pay for his time if I did not cancel within 24 hours. I feel concern for other patients who may have really needed that time, which instead was not dedicated to patient work. Paying my therapist reminds me of the significance of my missing the session (which would require that I be on my death bed!). It also simply feels respectful of his time. I understand the negative reactions, also. For me, it can seem like one more way in which my therapist has more power than I in the relationship. I wonder if this is just one more way in which my therapist has more power than I. The imbalance of power that is necessarily part of the therapeutic relationship always results in the most frustrating dynamics, frustrating interactions and “policies.” Just a thought.

  • Bill

    Bill

    January 17th, 2017 at 8:29 AM

    I think that it’s important for mutual accountability. As a clinician, I do the same thing as Lauri’s therapist. If I miss a session, except in case of a dire emergency, I will re-schedule with the client as soon as possible and not charge them for that session. I believe this fosters a sense of justice and equality in the therapeutic relationship – and it’s certainly how I’d want to be treated in such an instance.

  • Ross

    Ross

    September 24th, 2016 at 8:18 AM

    People who are professionals themselves will understand the importance of giving someone enough time to fill this space on their schedule and should respect the right of someone to ask for compensation when they are not given this courtesy.

  • grace anna

    grace anna

    September 26th, 2016 at 10:16 AM

    You sort of have to start out probably a little more accommodating to those things when you are first starting a business. But you know, as the business grown and you are more in demand, then you have to do what keeps your income level as well as your patients happy.
    I think that you probably have to walk a very fine line between those two things.

  • Jennifer

    Jennifer

    May 17th, 2018 at 4:20 AM

    But have you really ‘lost’ money if you simply move the appointment to a later time, have you not just delayed your payment? Unless the no showing patient never comes back, if they just reschedule asap, then you will recoup anything they would have paid in the original appointment. Anyone who wanted that timeslot the no show missed, would have found another time so it’s not really a loss as long as you don’t lose the actual patient, it’s only the appointment moving around. It’s not the same as a hotel which is a loss because it can only be held at that particular time.

  • Megan

    Megan

    May 19th, 2018 at 1:02 PM

    The problem is, it’s not always easy to just move an appointment to another time or day. Sometimes it’s possible that today doesn’t work, but there’s a time that works for both parties tomorrow. But it’s not always that simple. 1.) The therapist could be booked the rest of the week; 2.) What if the session was for a Friday and it’s the end of the week and it’s a client who comes weekly? You may not be able to reschedule that week’s session within that same week.

    Some therapists don’t charge if you reschedule within the same week. I personally saw a therapist who had that as a policy but I found that almost more annoying because it was hit-or-miss whether I’d be charged if I had to reschedule. It was up to chance – chance that she would have another opening in her schedule that week or that her other clients wouldn’t have already filled any openings/other cancellations. I prefer to know what to expect.

    There are just so many factors involved in whether you will have the option to reschedule and it really depends on each therapist and his/her schedule, number of days in the office, etc. I think some clients assume therapists are in their offices all day with free time- But sometimes that’s not the case. Many therapists are only in their office a few days a week and have schedules filled with back-to-back appointments and few cancellations. Sometimes, adding your reschedule into their schedule means adding another hour to their day, missing a lunch break, coming in on their day off, etc. which is not always convenient. You also have to think about the expense to the therapist – They are likely paying for rent (by the hour or day), utilities, and possibly childcare. Rescheduling for another day could result in additional expenses on their end, not to mention the extra time involved in communicating regarding the missed appointment and rescheduling options. This is minor for one cancellation here or there…But when you have several cancellations occur in a week or month it can take it’s toll on the therapist’s business and work-life balance. Charging for cancellations and no-shows is not something most therapists enjoy doing; however, it is part of running a successful and self-respecting business.

  • Pamela

    Pamela

    September 27th, 2016 at 10:57 AM

    You have to look out not for just your people that you work with but you also have to look out for yourself. The bottom line is that you have to be able to pay your bills too, just like everyone else does, so in order to protect that then you might have to at times make some tough choices and business decisions. They might not always be popular, but again, you have to protect your personal interests.

  • Heather

    Heather

    September 1st, 2017 at 12:57 PM

    My daughter’s psychologists charges the full cost of the appointment plus an additional $50 no-show fee. I pay a month in advance for the full cost of all the appointments. With the start of school, I spaced out on her appointment, and missed it completely. Totally my fault. I’m aware that I need to compensate her for my mistake. However, when I paying her in advance her full rate with no insurance, it seems odd to add an additional fee.

  • Galen Cole

    Galen Cole

    January 7th, 2018 at 8:53 AM

    Thanks for sharing. I just tweaked my policy to align with yours. Whereas I used to charge $35 for the first “no show” or late cancellation, and the full amount ($225 per hour for subsequent sessions), I have now raised my first time fee to $50. My logic is simple…I can easily fill a slot if I have enough notice which means that if I don’t have notice I lose $225. This is not ok since I’m in private practice and I have lots of expenses just keeping the doors open.

  • Jill

    Jill

    May 17th, 2018 at 4:31 AM

    As long as the patient rescheduled how have you lost anything? You would have to lose the patient, not the appointment to lose money. Any other patient who tried to book at that time would have asked for the next available, so unless you are losing patients who can’t get that timeslot that was missed, you haven’t really lost any money. It’s only if you are saying that a no show for one appoitment changes your actual clientelle that it would have an impact. I regularly showed up for therapy and then due to a lot of stress going on I completely forgot my appointment. I have never been disrespecful of my therapists time and had no intention of repeating it, the punishment was that I didn’t get to see my therapist as I had been looking forward to it and was very disappointed that I had gotten so distracted. However, I got charged the FULL amount, which is normally discounted with a rebate, which doesn’t apply for no shows. It was extremely hard to swallow when they called a month later to take the money for an appointment I never got and it really changed my relationship and feelings about going there. I don’t need to be treated like a naughty child and it felt really disrespectful to be treated like that just because I missed one appointment. I had been ongoing for a long time and was worth a lot of money to that clinic, now I’m left feeling bitter and insulted and considering if I want to return.

  • Megan

    Megan

    May 19th, 2018 at 1:22 PM

    I would encourage you to see your therapist again and discuss how the experience of being charged made you feel. In this case, it sounds like it was the clinic / a billing staff contacting you for payment (and just following the procedures you probably initially signed), so your feelings might be toward the clinic, not the actual therapist. But either way, sometimes, the best insights and growth come from discussions in therapy regarding conflict or ruptures in the therapeutic relationship.

  • Jennie, LMT

    Jennie, LMT

    August 7th, 2018 at 8:21 AM

    As a LMT, even with a reschedule, it can hurt when you expect that $ that week. The $ that comes into me, helps me feed my children and clothe them and pay for bills. So if there’s a reschedule it still can hurt in significant ways. Something to keep in mind. Having a policy in place is not for some people, it’s for everyone.

  • Michel

    Michel

    June 23rd, 2019 at 5:24 PM

    If a client reschedules and expects not to pay for the cancelled session, the therapist has now blocked out two hours and is only getting paid for one. If I’m in my office and someone cancels their 5pm session at noon, if I can’t fill it, it’s a wasted hour, and then I need to see them again?
    Clients should pay for missed sessions unless there is an emergency. Whether you charge a fee or the session fee, it’s completely justified.

  • SIRTRIZ

    SIRTRIZ

    May 30th, 2018 at 11:34 PM

    I missed an appointment because my therapist made, what I believe to be, an error in judgment in how she approached an issue of concern, which caused me to feel anxious to come back. I told her the day before in an email with 22.5 hours before my appointment my feelings of apprehension. She went ahead and charged me anyway, further putting a rift. This after I’ve been dependable for at least 4 years with her. I told her I didn’t feel it was fair to charge me the full penalty ($100) because I believe she had a part in why I missed the appointment. I don’t know how this is going to turn out. I feel very hurt. I’ve been a loyal client and appreciated her until the past few weeks it’s been bizarre.

  • Megan MacCutcheon, LPC

    Megan MacCutcheon, LPC

    May 31st, 2018 at 8:25 AM

    I’m really glad you shared this and that this post continues to get so many comments with personal examples because it really highlights what a touchy subject this is and how much grey area there is regarding cancellation policies.

    It’s important for therapists to have clear cancellation policies because they are, at the end of the day, running businesses. But I believe there absolutely needs to be some flexibility for situations like you described. I can see how you would feel doubly wronged here – being charged after a rift AND when you were so close to being within the 24-hour window.

    Some therapists are really strict about the 24-hour period and others are more lax. I personally don’t count down to the minute – Of course, the more notice the better for the therapist to be able to fill that slot, but if you let me know the day before, I consider that enough notice to not be a “late cancel” with a charge.

    I’m so sorry you experienced this – A rift in the relationship can really feel like a major setback in your therapy; however, it can also really be a chance for BOTH the client and therapist to learn and grow, especially when the rift can be effectively addressed and worked through.

    I would encourage anyone in a situation like this to have another session with the therapist and discuss how you feel. It’s so important – not only for you to express your feelings, practice assertiveness skills, stand up for yourself, etc. – – But also for the therapist to gain more insight into how the “business side” of their interactions impacts clients and the therapeutic relationship.

    Sometimes, working through a rift in the client-therapist relationship can be a real turning point in therapy that can open you up to all kinds of growth, insight, and connection that can help foster deeper work. However, if the therapist does not seem open to your feedback and does not validate your feelings and ultimately help to resolve your feelings of discomfort, then it’s definitely worth finding a new provider, as a positive connection between therapist and client is the #1 most important factor in whether therapy will be helpful.

    So bottom line is I encourage you to have another session to see if you can repair the relationship. And if not, don’t feel bad about finding somebody who feels like a better fit. Sometimes it IS time to move on and makes changes in your therapy journey!

  • SIRTRIZ

    SIRTRIZ

    December 24th, 2018 at 3:31 PM

    It’s been awhile since this happened. I had another appointment, but the whole thing turned disastrous. She terminated me. I feel the whole situation was handled very poorly. This after over 4 years of me being a good client and trusting her fully. She attempted to set some boundaries, which I fully believe were unfair…not really boundaries, but rather walls. I can’t for the life of me understand why she took such a hardline stance after all this time. I keep hoping someday she will apologize for her part in this. I really trusted and appreciated her. But I suppose there are too many legal fears for her to reach out and apologize. I’ve run this by other people, and I know she handled all this very poorly. If anything I wish a therapist could step up and admit their part in a conflict and try to set it right. Even several months later I feel extremely hurt. I attempted to try a new therapist, but it felt all wrong. Thankfully I do have a friend who is a retired therapist so can consult with him and that feels right. But I wish she would take initiative to right her wrongs. She did this at a very fragile point in my life.

  • Marissa

    Marissa

    October 8th, 2018 at 3:09 AM

    I would like to know if its legal okay to charge the full price for a therapy session what is canceled way in advance like days. I understand the 24 hour policy but I get still charged even if I cancel a week ahead. This is a verbal agreement made on my low point in life. what to do?

  • Megan MacCutcheon, LPC

    Megan MacCutcheon, LPC

    October 8th, 2018 at 8:43 AM

    Marissa – Most therapists seem to have a 24-48 hour window cancellation policy, but I do know of one who requires a weeks notice. She does, however, try to be very accommodating in terms of rescheduling within that same week. If your therapist charges for appointments cancelled that far in advance without giving you much option to reschedule, I would think that is unfair and unreasonable. But it’s not illegal if it’s in his/her policy. All therapists should have their cancellation policies very clearly stated, with clients reading and signing prior to starting therapy. It is important to understand the policies ahead of time. Unfortunately, many people are in the habit of not reading the policies before they agree to them. I would ask your therapist to review the policy with you so you are clear as to exactly what to expect. If the therapist doesn’t have the policy in writing, I would question their ethics/professionalism.

  • Marissa

    Marissa

    November 20th, 2018 at 3:26 AM

    Thank you for your comment.

  • KBC, LCSW

    KBC, LCSW

    November 19th, 2018 at 10:39 AM

    I am part of a practice that does charge for no-shows and late-cancels. I do routinely hear patient complain that we are “all about the money.” When I was a younger clinician, I would bend over backwards to dispute this. However, having had some years to grow more comfortable in my role, I no longer react this way, because yes, it IS about the money–at least somewhat. We are here for many reasons, but we are running a business at the end of the day. If we cannot generate income, we cannot sustain the business, and then we are unable to serve our patient/client population.
    Everyone’s time is important, and everyone has emergencies. But if we waved a cancel fee for every emergency, then we would be underwater quickly.
    My feeling is that every consumer deserves one pass–after that, even in what would be considered a legitimate emergency, the charge should be applied. This takes the guess work, guilt, and subjectivity out of deciding who and when to charge.
    Just to flip the scenario–I have worked FFS roles where I spent 8 hours in the office and was ultimately paid for only 3. If this happens two or three days per week, I am in a bind. I cannot tell my mortgage company or my childcare provider that my clients didn’t show up and my payment will be late, or short. I am still responsible for my bills. This made life very difficult, and it’s why a lot of good providers leave these types of positions, where there is no way to hold clients accountable and the clinician has to eat the costs of missed appointments.

  • AAArt

    AAArt

    January 15th, 2019 at 2:30 PM

    My psychiatrist and me were transitioning from a 90 minute appointment to a 60 minute appointment. We never spoke to whether the new appointment would start on the hour or the half hour. The first appointment was scheduled on the hour but on a different day because she had a conflict. The next week I showed up on the hour and she said I was late. She had no client one half hour before or after me. I am always on time and rarely cancel. I wanted to end the session in the 20 minutes remaining and pay half since it was a mutual misunderstanding. She disagreed. How can I continue with her?

  • Megan MacCutcheon, LPC

    Megan MacCutcheon, LPC

    January 20th, 2019 at 12:09 PM

    Hi AAArt – Wow, that does not sound right! If you had scheduled on the hour, and never implicitly discussed the session was (in her mind it sounds like) supposed to start on the half hour, I do not see how you were late! So sorry you had this misunderstanding and felt penalized. I hope you and the psychiatrist can discuss it further at the next session and work it out. I encourage you to be assertive about how the incident impacted you and made you feel reluctant about continuing your work together. Perhaps the psychiatrist (who is human and, thus, not perfect!) was having a bad day but will be in a better place to discuss this with you in the future. Keep us posted on what happens!

  • Lisa

    Lisa

    February 28th, 2019 at 11:02 PM

    I’m not ok with 24 hours in advance. A lot can happen in 24 hours. Sometimes you just can’t give 24 hours. What about considering case to case? I realize this could be costing them money,however my particular therapist charges 35,which is not an extreme amount but for those on a fixed income it very well may be. Not saying if your on a fixed income you shouldn’t pay, but perhaps less or even waived the first time.

  • Mike

    Mike

    March 1st, 2019 at 10:44 AM

    Lisa, my own therapist requires 24 hour notice for things that are under my control, but doesn’t charge for cancellations for emergency reasons or sickness. I agree with you that sometimes you can’t give 24 hours notice, but the point with most therapists (I would hope!) is that they would charge for things that you *should* be able to give 24 hours notice about, like ordinary plans.

  • Mychal

    Mychal

    June 2nd, 2019 at 1:19 PM

    i have spa providers that are paid per services. If a client cancels less that 24 hours how do you pay your providers? The full services amount? A percentage of the cancellation fee? other?

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