Cancellation Fees

Hi Matt,

Just out of curiosity I was wondering if you’ve ever charged cancellation fees?  On my clinic policy form I have a $25 same day cancellation or no show fee but to be honest I never feel comfortable charging it.  Though cancellations come up fairly often, I think I’ve only invoked it maybe twice in almost three years and both times it was because the person offered to pay it.  And I’ve only had one person where the no show’s were a problem and I was going to switch him to a same-day only appointment but at that point he stopped coming anyway.  Wondering what you do in your clinic?

Thanks!

We don’t charge for no-shows or last minute cancelations but that is just the way I have felt more comfortable about that issue over the years. All we have is a line on our appointment cards asking that people contact us as soon as possible if they need to change or cancel. I think it is a good idea though to have a sign like yours stating you charge even if you mostly decide not to. Like you, we sometimes have patients insist on paying and we usually decline but sometimes we accept. This is not an issue I have strong feelings about and think it is OK to charge for no-shows/late cancellations. I decided not to in my first couple years because my schedule was not completely full so a no-show was not really preventing someone else wanting to see me to be able to do so. Plus, I wanted my patients to know the money was not my main motivation. Now that I am so busy, I am actually fine when someone cancels at the last minute or no shows because I am constantly working on other things every spare minute like this site and other projects I stick my nose in. My wife as office manager is not so happy about it though because she is the one trying to accommodate everyone.  

The most common so-show is someone scheduling their first appointment. Since we schedule extra time for that and we don’t yet have a relationship with that person – that is a bit of a pain. 25 years ago, Mikki Shima who has a super busy practice in Marin County (a wealthy area by San Francisco) told me his office’s policy for new patients was that they require them to give credit card info and tell them that if they no-show or try to cancel with less than 24 hour notice, they will charge their card for the visit. I felt that made sense for his type of practice and his clientele (you’re the man, Mikki) but not for my practice. I just don’t want to set-up any chance for confrontation or ill feelings between those I am trying to help. For me, I made the decision to not go after people for that and never regretted it. I work at cultivating a healing, nurturing qi in myself and my practice and feel the better job I do of that, the financial stuff will take care of itself.   

Matthew Bauer

Thanks Matt!  I appreciate your point of view – it puts into words how I’ve been feeling about it and I will continue on with doing what feels right.  It’s the weighing of all of the different opinions “out there” mixed with some internal self-doubt – but it really feels right to me to not charge, though I’ll leave the policy in place to keep it open as an option. 

Recently I had a couple of new doctor visits (me as the patient) and both of them had pages of financial policies asking for credit card numbers and threats of what would happen if a bill is unpaid.  Although I understand the business/insurance reasons why they are doing this, it just left me with a big feeling of “ick” before I’d even met either of these two.  I don’t want to create that feeling in my patients.

Your welcome. It is really about cultivating the best qi in your practice environment and if you feel awkward about charging for no-shows and last minute cancellations that will not be helpful. Others won’t feel awkward at all and that is perfectly fine too. And thank you so much for your post offering your experience on lowering your fees. Your wording on the notices you sent your patients was great and having people on this Forum helping others here is exactly what I am trying to encourage.

Matthew Bauer

We recently had a nice thing happen to us with a patient who missed two appointments and forgot to call us and I wanted to add this experience to this thread. This patient eventually called us and apologized for missing those two appointments saying he had gotten distracted with getting ready to go on a long RV trip. He offered to pay us for those two missed appointments ($40 each) but we told him we would not accept that and just try to remember his appointments from now on. Two weeks later, my wife got a little package in the mail with $80 in gift cards from a fast food place she had mentioned was her favorite (those albacore fillet sandwiches from the Habit are a favorite of both of ours). Of course, not every patient will be this nice but our experience has been that most people will very much appreciate not be charged for missed  appointments and your good will can be repaid many time over.   

Matthew Bauer

I have a 72 hour cancellation policy. New patients sign a form and leave credit card info if they don’t object. I have never had to bill a credit card. Clients rarely give less than at least 48 hours notice. I also send an email reminder to all clients the day before their appointment. I like Matt’s policy but needed to add some gravity to cancellations. The majority of clients are very respectful, but still I needed to set a boundary. 

Peter C Doyle

It was a standard sort of form; 24 hour window for canceling appointments, within that window was a $25 fee, no-shows were the treatment fee. First time is forgiven and there would be tolerances for special cases. I thought it was pretty liberal. I had thought about putting it in my Patient Forms download on my website but I didn’t because I didn’t want to define myself or my practice as making negative assumptions about new or established patients.

As much as I would like to explain that a cancelation out of the blue could have been filled by another patient in need if the 24 hour window had been honored, I don’t do that either because inflicting guilt on others isn’t my thing either, instead, I simply choose to take that time to read and review. I must admit though, I have very few cancelations at all anymore and had forgot I had this form until this posting.
Bud