Should I Charge Patients Who Don't Show up?

Missed appointment

posted by Mike Whitmer on Thursday, March 1, 2018

Question: Lately, it seems like more of my patients have simply missed appointments without canceling in advance. In the past, I've considered this a cost of doing business. But it’s really beginning to affect my bottom line. So, I’m wondering: Should I begin charging patients who don’t show up for appointments?

Answer: This is a tricky question. Ideally, you would be able prevent no-shows from occurring in the first place. Some doctors 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.

Appointment reminder systems may include text message and email reminders. Text messages are often preferred, due to the sheer number of emails that go unread. Some practices use reminder apps, which can include a series of messages to improve compliance. For example, the first message may be an email reminder, followed by a text message and finally a phone call the day before the appointment.

Despite the ways that technology can help busy people remember their appointments, prevention can only go so far. Consequently, some practices have started charging 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. Some empty slots may be filled with walk-in and same-day appointments, but probably not all of them.
  • No-shows waste your time, as well as any employees who have prepared for appointments, and time must be spent 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 employees have to deal with the angry phone calls that result.
  • Patients have been known to file claims in response to billing disagreements, and it’s not unheard of for a patient to complain to the state licensing board soon after receiving a bill they believed was unwarranted.
  • You may spend more money trying to collect no-show fees than you’ll get back.
  • Some third-party payers allow charging 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.)

It is important to adopt a policy and communicate it clearly in advance. Post your policy prominently, and ask new and returning patients to acknowledge the policy. Whatever your policy, make sure to apply it across the board. Any lack of consistency will send mixed messages and result in confusion.

Also, be aware of other reasons patients miss appointments. Some patients worry that the treatment will be uncomfortable. Or, they may mistakenly assume that their absence doesn’t hurt your practice— and may even give you a welcome breather on a busy day.

Naturopathic medicine depends on a close working partnership between the doctor and the patient. Before you charge for missed appointments, consider whether the negatives outweigh the positives. Some practices have decided it is better to terminate a patient who repeatedly fails to show up for appointments without canceling rather than charge patients for missed appointments.

If you have concerns about this issue, please let us know if we can answer your questions.

  1. office and staff
  2. patients
  3. 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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