No Shows and Late Cancellations

One of the questions I see pop up most often in the Abundance Practice-Builders Facebook Group (feel free to join) and in day-to-day questions I get from private practitioners is how to handle last minute cancellations and no-shows. I put these questions in two camps: the I-don’t-know-what-my-policy-should-be camp and the I-don’t-know-how-to-enforce-my-policy camp. Let’s talk about both. What Should My Policy Be? For the most part, you get to decide what your policy is. If you’re on insurance panels, read your contract thoroughly. They may dictate whether or not you can charge your clients for no shows and late cancellations. That sucks. If you aren’t on insurance panels or the panels you’re on give you free reign, I want you to consider a few important points in determining your policy.

1. You are running a business. I want you to decide on your no show and late cancellation policy as if your practice is full. There will come a time when you are packed and have clients who want to see you but couldn’t squeeze into your busy week. Write your policy with this in mind.
2. The policy is not meant to be punitive. I don’t believe in punishing or shaming clients under any circumstances. There is a distinct difference between coming from a place of punishment and coming from a place of boundary setting and maintenance.

Ok, so let’s talk specific no show and late cancellation policies. I’ll give you mine as an example in script form. It’s written clearly in both my informed consent and my financial policy forms but in the first session I say something like: “I know you signed a few forms before this appointment and to be honest with you, I don’t ever read those things when I’m signing them so I wanted to tell you the most important parts so we’re on the same page.” Then I do my limits of confidentiality spiel. Then I say some rendition of this: “The Financial Agreement is another form you signed. The basics of what it said is that you are responsible for payment at the time of service. I keep your credit card on file so if you forget it, it’s no big deal. If you need to cancel a session for any reason make sure you do so more than 24 hours before your session. This gives me a chance to contact the people who may have wanted a session this week but couldn’t get in.  If you cancel within 24 hours or don’t show up for the appointment you are financially responsible for the full fee of the session, which is $150. [it’s important for you to lay out the price here. That way if the client is using insurance or on a sliding scale they understand that it’s not their $20 copay or sliding scale amount]. If you let me know within 24 hours and I’m able to get someone in that slot, I won’t charge you. I’ll use the credit card I have on file for any no show or late cancellation fees and will charge it during the session you’re missing. Do you have any questions about that?” (as always, if this script works, use it.) People never seem to have questions for me. If they were to question the policy I would reiterate that I often have people who want to see me that can’t and that I want to create space for the people who are eager to do the work.  I don’t have a policy about how many no shows people can have simply because it’s never been an issue. My people show up or cancel well ahead of time. Being clear about my policy contributes to a sense of treatment buy-in. Some people do a one no show or late cancellation freebie. I don’t. If my client calls and is sick, their kid is sick, or they were in an accident on the way to session I waive the fee. In my opinion it’s totally reasonable to waive the fee for these things. If someone does no show I make sure we talk about it in the next session to see if it’s a relevant therapeutic issue. Again, not from a place of shaming or punishing, from a place of curiosity and support. How Do I Enforce My Policy? It’s A LOT easier, and more fair, if you do the verbal explaining on the front end. Here are a couple things to think about that may help you maintain your boundary:

1. Remember that as the therapist, you are responsible for modeling boundaries. Remembering this has been invaluable not only as a clinician but as a business woman. So, if you set a policy, it is your duty to follow it. Yes, policies can change, but don’t change them simply because you’re not great a boundary maintenance. If it’s a growth edge for you, commit to working on that.
2. You can sneak your financial policy in the informed consent and just let them sign it even though nobody reads it all. You can avoid the conversation. Here’s what will happen: the first time you try to enforce this boundary, your client will be confused. You will show them where they signed the consent. You will feel shady. They will pay the fee or try to negotiate with you. They may feel betrayed. It will impact your work together. Alternatively, you will feel too weird enforcing the policy so you won’t. Let’s avoid this dynamic. In your first session, after describing limits of confidentiality and any other intro to therapy spiel you have, tell them your policy in a matter of fact way. (see above).  The first few times you may feel uncomfortable bringing up money in the first session. Money is a part of their experience with this; avoiding the uncomfortable experience of owning that isn’t great modeling for clients. We invite them to share very intimate, hard things in their lives. If they can tell you these vulnerable things, you can say the thing that’s hard for you around money.

Expect it to feel really uncomfortable the first few times you charge for a no show/late cancellation or have the conversation in the first session. You can tolerate discomfort. What trips you up the most with no shows? What’s your policy? Let us know in the comments. Allison Puryear is an LCSW with a nearly diagnosable obsession with business development. She has started practices in three different states and wants you to know that building a private practice is shockingly doable when you have a plan and support. After retiring her individual consultation services, she opened the Abundance Party, where you can get practice-building help for the cost of a copay. You can download a free private practice checklist to make sure you have your ducks in a row, get weekly private practice tips, listen to the podcast, hop into the free Facebook Group. Allison is all about helping you gain the confidence and tools you need to succeed.