Do You Need a No Show Policy in Private Practice?
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- Опубліковано 2 сер 2024
- Do You Need a No Show Policy in Private Practice?
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Some of you asked that I do a video about no-show policies: do you need to have one, how much do you charge for a missed session, and how do you implement the policy? In this video I’ll break down the answers to your questions about no-show policies.
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This video is geared for therapists of all kinds, including psychologists, MFTs, LPCCs, social workers, and others in the clinical counseling field.
Welcome to Private Practice Skills! I’m Dr. Marie Fang, psychologist in private practice. I post videos offering tools I learned the hard way about starting and growing private practice so that you don’t have to.
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No-show policies. Fortunately for me, my supervisor made me enforce this policy as an intern. And I’m so glad he did!
What’s the point of a no-show policy?
1) your time is valuable
2) you are running a profitable business. Having a no-show policy ensures that clients take the process of therapy seriously rather than waste your time.
How much do you charge for a missed session?
Everyone develops their own strategy for this. If clients typically apply insurance to pay for therapy, you’ll need to check on what rules each insurance company has for such a scenario. Often insurance will not reimburse for a no-show, in which case it could be an option to charge the client your full rate out of pocket rather than simply paying their co-pay. Be sure to check with your state laws as well as all relevant insurance contracts to ensure you’re following appropriate protocol.
Are there exceptions to a no-show policy?
Many therapists waive the fee for the first time a client no-shows. This offers a nice opportunity to reiterate the policy so clients are fully aware the next time it happens. I tend to follow this practice, but the decision to do that is up to you.
It’s also worth naming for yourself what other exceptions you’re willing to make. For example, if one of my clients is in a car accident, is sick, or has a close family member who is sick, then I waive the charge.
Be sure to know what your exceptions are before you start implementing a no-show policy.
How do you implement a no-show policy?
This seems to be the big question! I know so many therapists who have no problem stating that they have a no-show policy, but when it comes time to implement it they might shy away and simply not bring it up or choose to waive the fee.
If you have a no-show policy, be sure to follow these tips in order to implement it well:
Include it in your informed consent. Be sure to name under what circumstances you charge, how much you charge, and how you will charge the client.
Repeat it in the first session. Most clients don’t read the informed consent paperwork. At the beginning of the first session I describe my cancellation policy right after describing the limits of confidentiality and I ask clients if they have any questions.
Remind clients of your policy when they don’t show. I usually say something along the lines of, “as a reminder I do charge for sessions cancelled within less than 24 hours, and will be sending you an invoice via email.”
Don’t apologize! This is huge! If you followed all the prior protocol, then the client knows they are fully responsible for informing you in advance if they need to cancel. I know for me I’m such a frugal gal that I can empathize with that feeling of having to pay for something that never happened, but this is also a key learning for clients to develop a sense of responsibility. Or if they’re not really serious about counseling, to give them an opportunity to consider whether they’re fully bought-in.
Circle back the following session. Make sure to invite clients to share if they have any questions or concerns about your policy during the next session that you meet. From my experience, the average client is completely understanding of the policy and can own what caused them to miss the appointment. However, from time to time clients may have a therapeutically relevant response towards you, and it’s important to address how they feel about what happened.
If it keeps happening, dive deeper.
I hope you found these tips helpful to deciding whether to develop a no-show policy.
Of course I have a no-show policy! You touched on this, but I also think it's good modeling to set an expectation and follow through with it. Once you start waiving fees, you can get into an uncomfortable dynamic where your client expects the fee will be waived OR they start fibbing about why they missed to try and have the fee waived. Yuck for both sides.
Of course you do! :) I completely agree. I also think this is where knowing your clients well come into play. I tend to work with highly accommodating clients who rarely take advantage. Sometimes waving the fee is a healing experience in these moments. But if I catch someone working the system I definitely get much tighter about when I would waive!
Another option that I've I really come to like it charging the full session fee for a no-show and offering a "make-up" session within the same week if possible. This has allowed for some flexibility, while still making sure I hold the boundary.
Great job!
Very helpful, thank you
Always helpful. Thank you for covering this potentially cringey topic! I especially like the part where you show that you know your audience and remind us not to, in my opinion, dismantle the process by apologizing.
Thanks! I encourage people not to apologize because I'm guilty of doing it early on. Even now I'm still feel tempted to do it - I'm only human! :)
Thanks Marie! Would you be willing to share your list of emergency circumstances that exempt a client from paying the no-show fee?
I find your videos very helpful. Could you please share a template for your consent form for tele -therapy?
I wish that insurance would allow us to charge a standard set rate across the board for late cancellations or no charges and just like car insurance when they get dinged with it, they would take the responsibility of increasing a clients co pay due to their "accident"history because no show fees are great and all but we only get paid if the ct pays us. if they quit therapy cuz they are mad about it, u can send it to collections, but thats more out of pocket cost for us and the ethics law make it dang near impossiblw to discharge based on outstanding unpaid balances until its gotten so bad u have literally worked for free and will likely never see that money again!
I wish my company can implement this. It sets boundaries for clients which is essential in therapy. Thanks for sharing!
It does make a huge difference not only for your income, but in our client's commitment to growth.
@@PrivatePracticeSkills I completely agree with you! Also, do you ever have clients who are constantly showing up to appts late? What is your policy for that besides discussing the issue with the client if it does occur? I know sometimes life happens and sometimes my patients are ok with shorter appt or choose to reschedule. It's just that working in a non-private practice setting requires me to see them no matter what. I'm definitely sure I have more space to wiggle in my own policy if I do set up a private practice.
Have you ever had a patient refuse to pay when you send him/her an invoice? What do you suggest we do with such noncompliant patient?
The only No Show I have are the ones I am doing for free strangely enough
What do you do if they don’t pay the fee ?
I understand we can't charge Medicaid/Medicare clients for understandable income-based reasons, but I don't think it's fair that some commercial/private insurances should dictate whether we charge a fee or not. They already underpay us-it feels like a slap in the face for them to devalue or time by forbidding n/s fees. But yes, good to double-check contracts. :-)
It is bizarre that insurance has that authority! But what can ya do? Though that is one of many reasons that I've personally opted not to accept insurance. To each their own!
Hey Marie, I think my new psychotherapist takes everyone's credit card before the first session- does that mean for sure they have the same "no show" policy as you so even more incentive for me not to miss session?
Just to clarify, if a client DOES cancel before the 24 hours, you don't charge them?
Do you have any thoughts for new client no shows? I struggle this problem and it’s quite frustrating.
Yikes! That is rough when that happens. I talk about this a bit in my video about the initial phone screening: ua-cam.com/video/HfpcuoNtO8Q/v-deo.html
I've found that if I'm really thorough at the beginning, then people who would otherwise no-show for the first session don't even bother booking an appointment, and those who do book are already pretty invested.
I have not been able to collect a no show fee and Medicaid doesn’t allow you to bill the client a no show
This is a great point. It's very important for those going through third party payers to check with the policy if charging for a no-show is allowed. You're right that in most cases we're not able to still bill the insurance or charge the client in this case.
you can consider charging a deposit...