Missed appointments

[Village]

Hi guys
Just started my private practice and trying not to lose money from no show appointments. Was thinking about having a credit card on file for all patients especially new patients and if they dont show then card is charged. What are your experiences or advise with such issues?

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[Doc1401]

Hi guys
Just started my private practice and trying not to lose money from no show appointments. Was thinking about having a credit card on file for all patients especially new patients and if they dont show then card is charged. What are your experiences or advise with such issues?

One concern could be false accusations against you for fraud, eg. Patient complains that he/she never actually made the appointment.

 

[TexasPhysician]

I don’t see why you couldn’t assuming no state law prevents it. Downside is that credit card companies will reverse charges in a dispute without proof that owner agreed to the charges.

 

[deleted480308]

If you were worried about credit card disputes, you could just put a fee on their bill when they no show and just not let them book another until the fee is signed for and paid.....

I had a pcp that had a $20 no show fee.....they just made you pay the next time you got to the waiting room and you didn’t get to the doc until you paid

 

[Merely]

The psych in my area has a 50 dollar no show if you don't cancel before 24 hours of appt. it's in the patient forms that they sign before first eval. If they don't wanna pay it they can find another provider because they can't book another appr without paying. It's pretty standard to charge for no shows or else everyone will start to no show if there's no consequences...

 

[Bartelby]

I recommend outlining the fee for missed appointments in your initial agreement (for instance, full fee if cancelled less than than 24 hours in advance). Then add it to their bill, and bill in the usual manner. If they are falling behind, take it up as a clinical and treatment-interfering behavior with them. If they fall too far behind (you can define what that means), inform them that you cannot continue to work with them unless and until they have paid up. Be ready with referral options for them, such as to a University clinic.

I would personally avoid charging credit cards without the patient's specific consent, even if it was outlined in the treatment agreement. That could create bad feelings, board complaints, etc. Personally, I would rather just write off the visit or turn it over to collections.

 

[romanticscience]

I recommend outlining the fee for missed appointments in your initial agreement (for instance, full fee if cancelled less than than 24 hours in advance). Then add it to their bill, and bill in the usual manner. If they are falling behind, take it up as a clinical and treatment-interfering behavior with them. If they fall too far behind (you can define what that means), inform them that you cannot continue to work with them unless and until they have paid up. Be ready with referral options for them, such as to a University clinic.

I would personally avoid charging credit cards without the patient's specific consent, even if it was outlined in the treatment agreement. That could create bad feelings, board complaints, etc. Personally, I would rather just write off the visit or turn it over to collections.

I agree with the above. I have found that a face to face discussion resolves things and people are willing to pay. However, charging their card without discussing it with them first has caused some conflict.


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[deleted343839]

You could require a small deposit to secure new patient appointments, though you might deter new business in doing so.

 

[TJRock]

Do you plan to pay your patients that have appointments if you have to cancel for whatever reason the day of the appointment? Or is this charge a one-way deal?

 

[birchswing]

Do you plan to pay your patients that have appointments if you have to cancel for whatever reason the day of the appointment? Or is this charge a one-way deal?

My aunt has a doctor that gives out gifts if she's more than 10 minutes late:

"Dr. Wible: I’m scheduling my patients myself so if I am running more than 10 minutes late I have a gift basket and people get to pick a gift like a locally-made soap or lotion. I know my patients like the back of my hand so I know when the traumatic brain injury patient is scheduling an appointment with me that I want to put her at the end of the day because it takes her longer to get her sentences out. You know what I mean?"

Meet The Inspiring Docs Behind These Innovative Clinics | Pamela Wible MD

That's pretty unusual, though.

My current psychiatrist always sees drug reps before patients even when the drug reps arrive after patients who have a scheduled appt. One time a drug rep even mouthed "sorry" to me as he was walking in. I actually confronted her once and she said she takes them back first so she has more time with her patients and can get the drugs reps over with faster . . . (eyeroll emoji) And when she cancels, there's no reason given except "Dr. X can't see you because she won't be here that day."

I don't expect remuneration, but I do appreciate a quickly rescheduled appt versus being put off another month which is what happens.

 

[WisNeuro]

Do you plan to pay your patients that have appointments if you have to cancel for whatever reason the day of the appointment? Or is this charge a one-way deal?

One-way deal. Just how the cookie crumbles.

 

[Jules A]

If you were worried about credit card disputes, you could just put a fee on their bill when they no show and just not let them book another until the fee is signed for and paid.....

I had a pcp that had a $20 no show fee.....they just made you pay the next time you got to the waiting room and you didn’t get to the doc until you paid

This. And also an organized telephone or text reminder program. We charge $50 and if two no-shows they are discharged unless extenuating circumstances. They sign an agreement outlining this and our office staff will remind them if they are attempting to cancel an appointment with less than 24h notice. You'd be surprised how many emergency cancellations are able to attend when prompted they might lose future services.

 

[WisNeuro]

This. And also an organized telephone or text reminder program. We charge $50 and if two no-shows they are discharged unless extenuating circumstances. They sign an agreement outlining this and our office staff will remind them if they are attempting to cancel an appointment with less than 24h notice. You'd be surprised how many emergency cancellations are able to attend when prompted they might lose future services.

My clinic is now booking 2+months out. We always remind someone that a cancellation/no show will result in the loss of that slot and we let them know the approximate wait for a reschedule. That definitely helps to limit the no shows. I think I've had 3 in the past 6-7 months.

 

[futuredo32]

In my patient registration form it clearly states and I review it with the patient as well that any appointments not cancelled with at least 48 hours notice are full fee, so for a therapy appointment, $175. This is the norm in the area where I work, but their full fees are higher. I have lost one patient due to this, c'est la vie. For new patients, some physicians send out emails that have to be mailed back and it states on the form that they must pay if they don't come to their first appointment. I haven't done this YET. I make quite a bit from no shows. If a person is sick or there is a ton of snow I let it go, otherwise, nope. And if they are "sick" a lot, they need a Drs note.

 

[randomdoc1]

What about a security deposit model? In the process of seriously considering my own practice (currently an IC). To build it up faster, I was thinking of allowing pts to schedule their own appointments. For new patients they must pay $75 to secure the slot. If they come, it is refunded or paid toward their balance. If a no show, I just keep the money. Maybe they can acknowledge by clicking the pay button they are agreeing to this. Thoughts?

For my established folks, I give them a copy of the policies about charges for no shows. Plus, I send reminder texts when their appointments are approaching and give a short sentence saying they could be subject to fees as discussed if they do not cancel in time. If they still don’t show, they get a bill. I’ve lost minimal income with this method for established pts and no ones gotten mad. So there was good retention too.

 

[splik]

And if they are "sick" a lot, they need a Drs note.

my supervisor during residency used to say if a patient said they were sick to reply by saying "all the more reason to come to your doctor's appointment!" unless they are horrendously infectious or in the hospital, that is not a reason to miss a doctor's appointment.

 

[futuredo32]

my supervisor during residency used to say if a patient said they were sick to reply by saying "all the more reason to come to your doctor's appointment!" unless they are horrendously infectious or in the hospital, that is not a reason to miss a doctor's appointment.

By "sick" they are physically ill. I have a fair amount of patients with a lot of medical illnesses, if they are "sick" as in feeling sad, manic, anxious then yes they should see me but if they have something better treated by their PCP I would rather they go there (and take any germs with them 🙂 )

 

[splik]

By "sick" they are physically ill. I have a fair amount of patients with a lot of medical illnesses, if they are "sick" as in feeling sad, manic, anxious then yes they should see me but if they have something better treated by their PCP I would rather they go there (and take any germs with them 🙂 )

I know but you are still a physician. Of course it cen backfire one pt wanted me to listen to his chest and to antibiotics!

 

[futuredo32]

I know but you are still a physician. Of course it cen backfire one pt wanted me to listen to his chest and to antibiotics!

Yes and I have prescribed outside the scope of psych early on, but a peer said I could get in trouble if things went south so I stopped doing that. God knows I would rather be treating things other than psych issues................... But I am playing by "the rules"