When a Patient Doesn't Show Up


posted by Mike Whitmer on Thursday, June 01, 2017

Some NDs have been frustrated when patients miss appointments without canceling in advance. Although it’s a cost of doing business, it can affect the bottom line when it happens too often. What should you do?

The best policy is to prevent no-shows from occurring in the first place. Many NDs have had good results with practice communications that emphasize how missed appointments disrupt the practice, and an unfilled slot is a lost chance to help another patient. Other practices have set up telephone reminder systems to alert patients of an upcoming appointment, typically within the next 24 to 48 hours.

Even so, prevention can only go so far. Consequently, you may be considering charging patients a fee for missed appointments.

Like most aspects of practice management, there are pros and cons with this approach and some states may not allow it. As always, check with your legal counsel, managed care organizations and Medicaid/Medicare as appropriate before instituting this procedure in your practice.


  • In a busy practice, no-shows keep other patients from receiving timely naturopathic care.
  • Missed appointments deprive the no-show patient of needed care, as well as the continuity of care, and it exposes doctors to malpractice risk if an untreated condition worsens.
  • Unfilled appointments represent lost revenue that could have been avoided if the spot was filled by other patients.
  • No-shows waste the time spent preparing for appointments, as well as trying to determine why the appointment was missed.


  • Patients often resent what they perceive to be unfair fees. Not only may you lose some patients, you and any staff members may be at the receiving end of angry phone calls.
  • It’s not unheard of for a patient to complain to the state licensing board soon after receiving a bill they feel is unwarranted.
  • Sending billing statements for missed appointments costs you money in supplies and stamps. It also diverts time from more important tasks. It’s possible to spend more money trying to collect no-show fees than you’ll get back.
  • Some third-party payers allow charges for missed appointments, but others don’t. (Note: Medicare allows doctors to bill patients for missed appointments, as long as non-Medicare patients are also billed.)

Before you charge for missed appointments, consider whether the negatives outweigh the positives. Some practices have decided it is better to establish consistent policies rather than charging patients for missed appointments. For example, some doctors will terminate a patient who repeatedly fails to show up for appointments without canceling.

It’s also important to be aware of other reasons patients miss appointments. Some patients may mistakenly assume that their absence doesn’t hurt your practice—and may even give you a breather on a busy day. Others may have transportation issues. Regardless of the situation, patients may become more compliant if you work with them to resolve the issue.

As always, if you have questions about how to handle patient no-shows, don't hesitate to call NCMIC's Claims Advice Hotline at 800-952-9935.

  1. claims
  2. malpractice
  3. naturopathic
  4. risk management

About The Author

Mike Whitmer

Mike Whitmer is vice president of insurance programs at NCMIC. With over 25 years' experience in insurance and finance, Mike has in-depth information to share with NDs. He is responsible for NCMIC's corporate relations team and directing risk management education efforts for doctors, stud ... read more

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