Show Notes

Welcome back to the Designer Practice Podcast and I’m your host Kayla Das.

Has client late cancellations or no shows in your private practice thrown off your entire schedule and income? Unfortunately, this is a common phenomenon. But how do you handle late cancellations and no shows so that it doesn’t become a problem to your bottom line?

In today’s episode, we’ll discuss how to handle client late cancellations and no shows so that you can protect your practice financially.

What to have in place before a client no shows 

So, there are several things you can do before a client ever no shows. so that you can protect your practice financially.

Late Cancellation and No-Show Policies and Procedures

The first thing that I would encourage any therapist to do is have policies and procedures in place about what you’ll do when a client cancels late or they no show, as well as how you’ll handle it. Essentially, policies are the what and procedures are the how.

When it comes to having a policy, this should explain what constitutes a late cancellation. For example, is it 24 hours? Is it 48 hours? What is a late cancellation? Also, what is the cost of the late cancellation or no show? Is it the full fee of the session? Is it 50 percent of the session? And also explain briefly what you’ll do if a late cancellation happens. For example, will you process their credit card? Will clients be allowed or not allowed to return until the outstanding balance has been paid? And if there’s no credit card on file, you might even add a timeline for the receipt of payment into your policies. So, policies are what you’ll share with the client when they’re coming into your practice during the client consent stage, so that they are aware of what to expect if they do cancel late or not show up for an appointment.

Procedures, on the other hand, are the internal processes that you’ll take to enforce that particular policy. So you might not necessarily share the procedure with a client unless they ask specifically, but it’s something you and your team do in order to be accountable to that policy. For example, a procedure might look something like this:

When a client no shows to an appointment, the therapist notifies the client of the fee for session, and processes the client’s credit card on file. If no credit card exists, therapist will inform the client that unless full payment is received within 24 hours, no further appointments may be booked until outstanding balance is paid. Also, in your written procedure, you might even continue to say, if clients do not respond to an email, or do not provide payment, client will be flagged in the practice’s practice management software as a reminder should the client try to book a session in the future.

Having policy and procedures can help protect you and your practice a few ways. First, because you’ll include the policy in your consent forms, the client is signing off on that they are aware of and agree to this particular policy. So even if they forget that they have signed it, should there ever be a dispute, you have the written documentation that they were aware that this could happen.

Secondly, procedures keep you and your team accountable because there is a step-by-step process to take any time that this should happen in your practice. One of the questions that therapists ask all the time is “How do I handle client no shows?” And it’s really your private practice procedure that will dictate this

Now there’s no one right way to create a procedure, but your procedure should be agency specific, not client specific. So what I mean by that, this procedure should be in place for most if not all of your clients, not just in place for this client or that client and so forth.

One common mistake that I see all the time is that there’s different procedures or exceptions for different clients, which can create administrative headaches, as well as it provides inconsistencies with how you’re treating your clients.

Now, does that mean if a unique situation arises, you can’t make an exception? No, of course not. But if you fly off the seat of your pants and not have procedures to follow, how you handle a situation may not be consistent, and consequently, you may be losing revenue and inadvertently creating inequality among your clients.

Payment Methods on File

Also, if you use a practice management software to maintain your client information and process payments, which I totally recommend, by the way, then your procedure may also outline that client credit cards are to be obtained during the intake process and to be securely added to that particular system for processing payments in the event of situations such as late cancellations or no shows.

This has been on more than one occasion, something that saved me in my practice. In my private practice, it was a part of my procedure to obtain a credit card during the intake process from clients. The credit card on file was only used in the event of a late cancellation or no show. Although sometimes clients want me to process their credit card after each session, but I would get verbal consent for that in each session if they wish to do so, just because it makes their life a little easier. But I would only use it otherwise for late cancellations or no shows.

If a client did cancel late or no show, I would email them as I had another policy in my consent forms allowing me email communication. And I would remind them of the policy and the amount to be paid, that if I didn’t receive a payment from them within 24 hours, that I would process their credit card on file. And then I would process the credit card 24 hours later if, of course, I didn’t receive a payment otherwise. I’ve never had any disputes or issues with this. Although there has been a couple of times where clients didn’t return after I processed the no show payment. But I personally don’t believe it had anything to do with the process payment. I feel it was probably for some other reason, which may have even led to why they no showed to the appointment to begin with.

You might be wondering what if a client doesn’t want to give a credit card or doesn’t have a credit card? Do you still work with them? In my private practice, I still work with clients who didn’t have credit cards on file, but I knew it was a potential risk should there be a late cancellation or a no show. And that I may also not be compensated for the time that I otherwise could have made. But it was a risk I was willing to take. But having a credit card on file was something that I requested on intake because I really didn’t want to risk my revenue over time.

What to say when a client no shows

So now that we’ve discussed what to do prior to a no show, let’s dig into what to say when a client does no show. According to what your procedure says, you might either call or email a client to inform them of the payment for the missed appointment. If it’s a telephone call that you choose, you may find it helpful to have a script in your procedures, whether it’s you or your team calling, just so that you’re consistent throughout your phone calls with people. Similarly, if you want to send an email, you might have a template created with what you’ll say, and then just plug in information that is specific to that client. For example, an email might look something like this:

Dear so and so,

As you have missed your appointment today, I would like to remind you of our late cancellation and no-show policy that states: [And then of course you would state what you would say].

In accordance with our agency policy, we request that you submit a payment of, [And then you give the amount of the payment, and I also like to bold the amount that they owe] within [And then I would also put within what time frame, and then I would bold that as well].

Otherwise, we will process your credit card on file. After a payment is received, if you would like to book another appointment, please let me know, and we can reschedule at a time that works best for you.

Or something on that line.

As I mentioned earlier, you could have this as a template added to your written procedure so that you have an email created so that you can continue to use in similar situations, so it takes less time administratively to create these emails to send to clients.

What to do if a client doesn’t show up

So, now that we’ve discussed what you would say, let’s actually talk about what you would do if a client doesn’t show up and the possible steps you can take in regard to this.

So, first of all, notify the client of the missed appointment and remind them of your policy regarding late cancellations and no shows and the process that you have to recoup payment in this scenario.

Secondly, if a client doesn’t provide payment in the time that you outlined in your call or email, or you’re unable to process their credit card for whatever reason, you have a few options moving forward. One, if it’s a part of your policy, you can inform the client that you didn’t receive payment and that as per your policy, you won’t be able to see them again unless they pay the outstanding balance. Two, you could hire a collection agency to try to recover that payment. Three, you can really do nothing because you probably already outlined your policy in the email or the phone call and the consequences of not paying in the first step.

If you choose to hire a collection agency, there will be a process in that in itself. And it’s important to ask yourself if the amount of time that you’re putting in to try to recover this payment is worth the time, effort, and potential costs that you’re going to incur as a result of this to try to recover the payment from the client.   

If you have a policy in place that you’ll only see a client after they have paid the outstanding payment for the missed appointment, you’ll only have maybe max a couple hundred dollars that you are missing in regard to a lost payment. Whereas the time, effort, and cost that it would take to hire a collection agency will be much more than that.

In addition, there are potential ethical considerations when it comes to enlisting a collection agency to recover outstanding fees, as you’ll need to release some personal information about the client to the outside party. So before going this route, it may be wise to review your regulatory body’s standards of practice or code of ethics, with respect to this situation and enlist legal or risk management advice, if you’re unsure about the process or risks.

Interestingly, I searched for some Canadian specific resources with respect to therapist hiring collection agencies, and I really couldn’t find any. But I have found an article from the American Psychological Association (n.d.) written by a risk management professional named Eric Harris about managing debts for psychologists. And there are some key considerations that I take away from this article that I’m going to share with you.

One of these key considerations is that nonpayment by clients is a business issue and not a clinical issue. So, he suggests that communications with clients involving anything other than like the business reasons for payment may be, and I quote, “legally and ethically risky.”

Secondly, that enlisting a collection agency must only be used when all other options for recovering the payment is exhausted.

He also states, if a collection agency is hired to recover the cost, that only minimal information should be released about the client, and typically that only includes the general description of the services, the date of service that you’re trying to recover and the amount owed.

He also states that an understanding that the creditors main source of recouping payment is to harass the client which is often counterintuitive to the psychologist’s mission and ideology of work that they do.

In addition, when hiring a collection agency, you can still be held accountable for the collection agency’s actions. So, choosing that agency you work with wisely is important.

And then finally, he states the clients may also retaliate and become disgruntled, opening the situation up for additional implications or consequences, such as regulatory complaints. Another thing that I’m thinking of too is potential negative reviews, like things that could definitely come back to impact you.

In the article, some of the points discussed in this episode were reiterated, that developing policies and procedures regarding missed appointments and no-shows is your best strategy for handling and combating payment related issues. So going back to everything we discussed today, really thinking about how can you create these policies to help protect yourself.

So, this article is a really great read. I’ll actually link to it down in the show notes if you’re interested in reading more.

Personally, when it comes to one-to-one clients, I’ve never sought a collection agency in my business because my policy is clear about missed appointments. I obtain credit cards to recover payments, and if a credit card isn’t on file or I’m unable to process that credit card for whatever reason, I email the client requesting payment, which sometimes I do receive the payment, while other times I haven’t. But because I have these policies in place, I’ve been able to recover most of the cost for the late cancellations and no shows than if I didn’t actually have these policy and procedures. And when it comes to hiring outside for a collection agency, it just isn’t something that I’m willing to do. And if I were to do it, I would seek legal or risk management advice prior to proceeding.  

But at the end of the day, only you can determine which route is best for you and your practice. So, these are just some of the steps that you can take.

So, when it comes to how to handle late cancellations or no shows, having clear policies and procedures, obtaining client credit cards at intake, and implementing your own policy and procedures are going to help protect you and your practice recover the outstanding costs from missed or no-show appointments.

Thank you so much for tuning in to today’s episode and if you like this episode or the Designer Practice Podcast as a whole, I would really appreciate if you would share this podcast with a colleague or someone in your community so that other therapists can tune into this podcast as well.

Until next time, bye for now.

Credits & Disclaimers

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References

American Psychological Association. (n.d.). Managing with fee balances. Retrieved from https://www.apaservices.org/practice/good-practice/fee-balances.pdf