Appointment Time

How To Get Paid For No Shows

Creative Commons License photo credit: Marcin Wichary

Are you going to work and not getting paid?

Therapists in my consulting practice frequently complain of a high no-show rate, especially with new clients. They often feel powerless to enforce their policies fearing if they're too strict, clients will drop out of treatment.

I used to have this problem, too, and ended up feeling resentful when I had rushed to get to my scheduled session only to have a client no-show. There were also those days when a handful of clients who didn't show up or cancelled at the last minute. Since I was paying for child care there were times when I actually lost money by going to work. I knew something had to change.

While some clients would pay for the no-show or late cancellations at their next appointment, others would drop out of therapy, not return phone calls, and not respond to bills I sent to them. Additionally, many of the managed care panels I participated on at the time didn't reimburse for no-shows, and our contract didn't allow me to charge the client for sessions not attended. This was another reason I resigned from all managed care panels.

May I have your credit card number?

A few years ago, I started requiring new clients to provide a credit card number before they could schedule an initial appointment with me or any of the therapists at my clinic. New clients were informed that they would not be charged until the time of service, but that our policy is to charge the therapist's full-fee for no shows and cancellations made within 24 hours of the schedule appointment time.

If hotels, massage therapists, and hair salons can require a credit card to hold your room or appointment, why can't therapists require clients to make a financial investment in their treatment the actual sessions? Surprisingly, we've had no resistance from new clients when my office manager tells them about our policy and ask for their credit card number. Not surprisingly, my practice has very few no shows or late cancellations and the few that we do have, we charge for.

For my clinic of 13 therapists our percentage of no-show or late cancellation sessions that we don't collect our full-fee is less than 1% of our total number of sessions.

Suggested script for taking credit card number

I have an amazing office manager who screens all new client inquiries, informs them of how to access new client paperwork, takes down the credit card number and explains our financial policies Here's an example of what she says.

Yes, Julie has an opening next Wed. at 3:00PM. In order to confirm that appointment with Julie we require a credit card number on hold. You will not be charged until the time of service and you're free to use another form of payment at your session. What type of card would you like to use?

If for any reason you are unable to make your scheduled appointment time please give us at least 24 hours notice of cancellation or we will charge your credit card for the full session amount. Do you have any questions?

Tightening up our no-show policy has:

  1. Weeded out the clients who aren't ready to commit fully to the therapeutic process.
  2. Motivated our clients to be in charge of their appointment times and give us ample notice if they can't attend a scheduled session.
  3. Allowed my therapists to get paid for sessions whether the client shows up or not.
  4. Saved administrative costs and collection fees.
  5. Trained clients to value and respect our time and services.

Is it time to tighten-up, modify, or enforce your no-show or late cancellation policies?

What challenges do you face in enforcing your policies?

A Day In The Life: Meet Body-Centered Therapist Ashley Eder, LPC

Ashley Eder, LPC Meet Ashley Eder, LPC and her therapy dog "Angel." While I know therapists who've brought their dog into the therapy office occasionally (it wasn't necessarily "therapeutic" for colleagues or clients), Ashley is the first therapist I've met who uses a therapy dog as a purposeful tool in clinical practice.

It makes sense that certain clients would feel at ease and find contact with a dog to be calming during therapy sessions. In her Boulder, CO private practice, Ashley specializes in body-centered psychotherapy and mindfulness interventions to treat somatic complaints, such as body image, self-harm, chronic pain, abuse recovery, and eating disorders in young adults in their teens and twenties.

In addition to her clinical practice Ashley provides counselor education, training, community building and supervises other counselors toward licensure. See how Ashley spends her day balancing family (she's a mom of one) and her clinical practice.

A Day In The Life

January 23, 2012

6:50AM

Wake up to the sound of my 15 month old son chattering to himself in his bedroom. He is currently my alarm clock, and this is an excellent arrangement when he sleeps past 6AM. I listen to him babble and do a quick first check of email to see if there is anything I need to know heading into my day.

7:00AM - 8:30AM

This is a whirlwind of play, feeding, diapering, getting dressed, and chasing a toddler around the house. My son decides today is the day he wants to learn how to climb the stairs. My husband makes us some coffee and I eat my own breakfast. We divide and conquer morning tasks like feeding our pets and unloading the dishwasher. I check email again and see I have one cancellation for this evening, and one client in crisis and requesting a phone consult today (no safety concerns). I’ll get back to both of them as soon as my son heads to daycare.

8:30AM - 9:00AM

Check in with my client in crisis over the phone. Return email to the client who needed to cancel confirming our regular appointment time next week.

9:00AM - 9:45AM

Shower and get dressed. Get my therapy dog Angel ready for work and in the car, then we head to the office. I have a short phone conversation with a colleague whose caseload I’ll be covering the next two weeks while she is out of town. I also call my son’s pediatrician to let them know that he still has the cough I brought him in for last week.

10:00AM - 10:30AM

I get settled in to see clients. This includes tidying up my office, making sure there is water in Angel’s bowl, and pulling charts for the clients I’ll see today. I have recently switched to electronic record keeping and have a personal goal of all case notes completed for the day before I leave the office. This keeps me from getting behind. I take a few minutes to sit quietly.

10:30AM - 3:00PM

I have four consecutive sessions with a half-hour break mid-way through. It’s the beginning of the school semester and my roster today reflects that students’ schedules are in flux, which means mine is too. This time flies. It is so rewarding that it’s energizing and I feel grateful for this work.

3:00PM - 4:30PM

A break. Angel and I go for a walk to stretch our legs and get some fresh air. We eat lunch by the pond outside my office where a pair of ducks is over-wintering. Angel loves to watch the ducks. Back in the office I check in with friends over Facebook and email. I return phone calls and schedule appointments with the two prospective clients who left messages this morning, and I schedule a supervision session with one of the licensure candidates I am supervising. I send a quick note to a colleague who has been a regular referral source for me lately.

4:30PM - 5:00PM

I participate in a half-hour informational interview over Skype with a college graduate from my alma mater. She contacted me via LinkedIn for advice on applying to graduate school and pursuing a career in counseling. I’m impressed by her initiative and preparation, and it feels good to help her out.

5:00PM - 6:00PM

My last session of the day. Because I have been charting all day I finish this final case note and log out of the electronic health record system by 6:00 PM sharp.

6:10PM

Pack my bag, draw the shades, lock my filing cabinet, vacuum dog hair from the carpet, leash up Angel, and head home.

6:30PM - 7:00PM

I come home where my husband and son have finished their dinners. Angel and I eat with their company and we talk about everyone’s day. My husband asks if Angel was a good therapy dog and I answer “of course.” I enjoy watching my toddler roam around the kitchen and family room. His curiosity is delightful and tomorrow we will spend the entire day together.

7:00PM - 7:30PM

Baby bedtime. We all go upstairs for the diaper change, pajamas, teeth brushing, and bedtime story.

7:30PM - 9:00PM

I finally make a dent in the pile of receipts from last year’s business expenses--time to get ready for taxes. Write a rough draft of a letter of recommendation for a client. Put the finishing touches on my resume and cover letter for an affiliate faculty teaching job I’d love to have.

9:00PM - 10:00PM

Hang out with my husband, who has also been catching up on some work that was left over from the day.

10:00PM

In bed, I skim through email and Facebook once more before going to sleep.

To learn more about Ashley Eder, LPC and her therapy dog angel, visit www.ashleyeder.com.

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