Have you given any thought to your cancellation policy? If not, you should. Cancellation policies provide clarity for your clients and reinforce professional courtesy and boundaries for you.
It is common for mental health professionals to require a 24-48 hour notice for clients to cancel a scheduled appointment. Under such a policy, the client who fails to give appropriate notice for canceling an appointment typically pays the therapist’s usual and customary fee. Therapists who implement this type of policy often stipulate exceptions for emergencies and illness.
"Cancelled" by Paul G.
My cancellation policy reads as follows: “ A cancelled appointment delays our work. When you must cancel, please give me at least 24 hours notice. I am rarely able to fill a cancelled session unless I know at least 24 hours in advance. In you are unable to provide at least 24 hours notice when you cancel, you will be charged the full fee for your session unless I am able to fill it with another client. (You should note that insurance companies do not typically reimburse for missed appointments.) The only time I will waive this fee is in the event of serious or contagious illness or emergency.”
Should you decide to implement a cancellation policy in your practice, make sure that you include it in your written statement of disclosure.
Wow! So interesting that you posted this today because just last night I was thinking about “Hmmm, I wonder what my cancellation policy should be? I should probably have one.” (I’m looking to start my own practice here in the next couple of months). I was thinking along the same lines as what you have in your policy (full fee if not 24 hours in advance, exceptions only for illness or emergency). I’m just wondering, however, do you find that anytime someone cancels it’s an “emergency”? Like do people come up with “my car broke down” excuses all the time? I guess there’s no way to regulate this and we just have to trust our clients when they say they are sick or have an emergency…I think probably the most effective part/biggest reason to have such a policy in place is because it means people will be much less likely to cancel in the first place. I bet you don’t have too many cancelled appointments, right?
Bkhappyfriday, welcome! And, thanks for dropping in to chat!
Before implementing a cancellation policy, I had clients cancel on the spur of the moment or simply “no show” because they decided to “go out shopping” with a girlfriend, “forgot” about the appointment we had, or “just didn’t feel like working.”
Those things don’t happen any more and here’s the reason why . . . . If clients aren’t self employed, they don’t often think about things from the perspective of the self employed. Before I was in private practice, it never occurred to me that by canceling my haircut or dentist’s appointment that someone else might be losing money. I just never thought about it . . . and probably canceled on the spur of the moment much more often than I would like to admit.
However, once I learned (from personal experience) that that sudden cancellation hurts . . . I changed my behavior and your clients will, too. It’s been years since a client stood me up. And, when she did, it was material for us to explore in our session.
If a client believes that a broken fingernail or needing to get a massage is an emergency, then I believe we need to be talking about it. Sometimes those things perceived by clients to be emergencies may be indicative of holes in their boundaries . . . like not being able to say “no” to a friend who drops by and wants to go shopping; sometimes, they may be indicative of difficulty prioritizing.
My clients hear me often stress the need for them to learn better self care. If getting her nails done or getting that massage is what she prefers to be doing than seeing me, I actually encourage that even if there’s not 24 hours notice.
Don’t get me wrong . . . those aren’t ever emergencies and I don’t waive fees for those things. However, neither do I shame my client or set her up to call them emergencies. I charge my fee (and clients do pay for them) but I frame such incidents as “prioritizing self care” and “choosing what is in their best interest” and those are things that I want my clients to value.
Bkhappyfriday, I hope you’ll join back in as we continue to build our community!
Think about it . . . . If my client is going to pay $100, would you rather she pay the money and sit through a session with you when she would rather be elsewhere? I think not! I think it makes much more sense for her to pay her money (because she committed to do so) and then to be exactly where she prefers to be . . . in a bubble bath, out shopping with friends, or whatever!
Hi Tamara,
Thank you so much for your quick and thorough response. Everything you said makes a lot of sense. I would definitely rather that my client do what is most therapeutic for them, and I also think cancelled appointments can be a great thing to explore in therapy. It also feels good, as a therapist, to recognize my own worth and have boundaries (like cancellation policies!) in place.
I’m so excited to have found this great resources and I look forward to your future posts.
Niloofar
Niloofar, feel free to introduce yourself and tell us about yourself. It’s a good way to start getting a little publicity . . . even for those who are not out of school yet!
I am trying to decide re cancellation policy in a new practice. I currently practice in another location and despite my cancellation policy, people cancel late quite often. Total cancellation rate per week is 25% most just in time to meet 24 hr cancellation policy which isn’t really enough time to do much with. This means that I can lose almost a days worth of income per week. I’ve been considering a 48 hr policy but cannot find anyone in my area who does that. I notice that you say 24-48 hrs on the site but you only use a 24 hr. one. I would be interested in feedback
Hi, Laura! Thanks for dropping in to join the conversation. Wow – 25% cancellation rate in a week is not the way to go, for sure! I use the 24 hour mark because I have virturally NO cancellations. However, if I started getting many, like you, I would not hesitate to use the 48 hour limit. And, I wouldn’t think twice about what other therapists are doing. This is about training your clients to abide by your boundaries . . . . 48 hours is not uncommon for professionals to use . . . even if they are not doing so in your area. (However, you might want to indicate below where you are so that others in the area that might be using a similar cancellation policy can compare to yours.)
Laura, is it possible that there is another reason for so many cancellations? I don’t have a clue about your particular circumstances but here’s what I tell other professionals who struggle with this issue. (1) It’s really important to put your cancellation policy in writing in your disclosure statement. (2) You absolutely must discuss this as part of your process for informed consent. (3) You must act as a professional at all times including dress, speech, behavior. To do otherwise, gives the impression that you do not need to be treated as a professional. (4) I tell clients that ours is a professional “relationship” and that I value and respect their time and that I expect them to value and respect mine.
What I know is that unless you are in business for yourself – especially in a service-oriented business – you may not realize the impact of no shows on a business. Usually when I explain to a client that a no show every day results in a 20% loss of income, that comes as new information. If the client and I have built a solid relationship built on respect and empathy, the client doesn’t stand me up. And, yes, I consider less than 24 hours to be “stood up.”
I hope this helps you clarify what you want to do about your own cancellation policy. If I’ve missed the mark, Laura, and your situation is decidedly different, I hope you’ll drop back in to clarify. I’m happy to help you problem solve with this situation because certainly you are not alone!
Looking forward to seeing you back here at Private Practice from the Inside Out! Have a good day!
Thank you. I am in Covington, GA. I do have the policy clearly stated in my informaed consent and review it with them. I always dress professionally and, I think, behave as such. I keep my boundaries clear. People who have been with me a long time, rarely cancel and to late cancel is pretty rare and some will even say “I know I owe you”. The worst cases are pretty new people. The absolute worse ones are people coming in on an EAP. I do see a lot of EAP folks and, at this point, take insurance. I think that does make a difference as I experience more of a sense of entitlement with those folks than with self pay. I have even had people say to me “why do you need my copay when you get all that money from insurance.” Of course, I explain that their copay is anyway from 25% to 75% of the total pay that I will receive. Many folks put us in the same category as doctors and seem to think that doctors are raking in the dough and are angry at the costs of health care. I usually try to talk with them about that and gently educate.
Hi, Laura, and welcome! Thanks for following up to let us know what you decided to do with your cancellation policy!
My experience has often been like yours with clients initiating the conversation with “I know I owe you . . . .” I do love clients that are willing to be responsible for their own behaviors!
I have found that my clients who are already self employed (or have partners / spouses who are self employed) rarely take issue with my cancellation policy and fees. It’s the clients who are employed by other people that seem to be most surprised / displeased. Once I explain both the relational aspects (including trust and mutual respect) along with the costs of running a clinical counseling practice, they almost always apologize and pay up.
That makes sense to me because until I was in private practice, I didn’t think twice about rescheduling on the day of an appointment with with my dentist or hair salon. But the first time or two I got stood up or a client called to reschedule so that she could go shopping, I got it. I got what it meant to a sole proprietor’s income when a client is unable or unwilling to honor their commitment to an appointment. That’s all it took for me to change my behaviors. Now, if I’m not contagious, I keep my appointments and I expect my clients to do the same.
Repeated no shows and last minute cancellations just don’t happen in my practice. I’ve set a clear boundary.
Thanks for the post Tamara. I have a clearly stated cancellation policy, but I have been thinking about rewording it, and that is how I came across your post.
I am a marriage and couples counsellor and part of my work involves helping people take responsibility for their actions and to have consideration for others. I feel enforcing a clearly stated cancellation policy is helping them to take these attitudes with me.
My problem right now is that I don’t take credit card payments and it seems that this is necessary in order to enforce the policy (any suggestions here would be welcome
). It seems that some people have no qualms about not showing up if they know you have no way to charge them.
Hi, Jean! Thanks for dropping in tonight!
I agree 100% that a clearly stated cancellation policy (and follow through with enforcement) is as much a clinical issue as it is a good business practice. I have at different times accepted credit cards and not accepted credit cards in my practices. However, that has not in any way interfered with my cancellation policy. I’ve always been able to collect my fee for no shows and late cancellations. It is important to have your policy in writing and to discuss it as part of getting informed consent. Then when a client cancels at the last minute (or doesn’t show for an appointment), I usually mention while talking to the client (or in leaving a message on voice mail) that s/he doesn’t need to worry about mailing in the payment. S/he can pay the fee for that missed appointment at the next session. Assuming the client returns for a future visit, I ask them to write a check for the full amount.
And, as you indicated, if there is no reason to cancel at the last minute, why wouldn’t you? Conversely, if you are charging your client your hourly fee, it’s most likely that they’ll do there best to show up and do some work with you!
Jean, I hope you’ll drop back in often to chat and let your colleagues know about the community we are building here at Private Practice from the Inside Out!
Hmmmn. I’m a therapist and a client. As a therapist I have a 24 hour cancelation policy and I find that it works well. My therapist has a 48 hour cancelation policy and it drives me crazy!!(not literally). I don’t know if it is because it is different than mine, and most people’s I know, but I tend to forget. I also tend to really examine my schedule for today and tomorrow, but not the next day. So sometimes I really am not sure/ready to plan to reschedule 48 hours ahead!
I understand boundaries. But sometimes things come up the day before, and two days is just sometimes too difficult. I’ve seriously thought of leaving this therapist (who I have only been seeing about five months) just because of this policy. I know that sounds really black and white, but I can’t afford to pay for me not being there. And I never once missed an appointment with my last therapist who I was with for four years. Between my clients and life being unpredictable… I just don’t find 48 hours being realistic…
Hi, B! Thanks for dropping in to share both sides of the issue! You make a valid point. The further out you set that boundary, the more likely unexpected things are to fall into the mix. I wonder if you spoke to your therapist about this issue if she would reconsider her own policy. Since you have experience as a therapist and a client, I would think your feedback would carry additional weight with her.
And, by the way, thanks for saying that you have your own therapist. There is such a stigma for mental health care . . . and even moreso for health care professionals who seek their own mental health care. I’m writing a post right now on self-care for therapists – something that was never even mentioned back in the 1980′s and 1990′s.
I hope you’ll drop back in here often and contribute to the conversation as we continue to grow our online community here at Private Practice from the Inside Out!
Hi Tamara, just a quick note. I use PayPal for the few credit card payments I receive for workshops and Skype sessions. PayPal is easy to use, and while the fees maybe a bit high I like the convenience. At some time, I may need to change how I process credit card payments but for now PayPal works.
The cancellation policy is stated in my Client Services Agreement. The policy is reviewed with clients and they are asked to initial this section when they sign the Agreement.
Dianne
Dianne, I agree with you. For low volume use, PayPal is a good option for psychotherapists.
And, your cancellation policy sounds very well thought out. Do you get any flack about it? No one has ever complained about mine.
I liked the comments here, and agree with the need for a clear cancellation policy. However, what was your response specific to the woman talking about EAP clients? I agreed that they were the “worst” because they get “free” sessions and if they don’t feel like coming, don’t.
All EAP company’s have the therapist agree in writing that they won’t charge clients for missed appointments.Most EAP’s say the client just looses this appointment. The therapist looses the hour, and the fee. To get around this, I offer EAP clients the “same” privileges as my non EAP clients: pay my $60 reschedule fee, or loose the session as the EAP company dictates. To date, they all prefer to “loose ” the session. Any suggestions about how to work this better without getting in trouble with the EAP company??
Hi, Claire! Thanks for dropping in here at Private Practice from the Inside Out to chat! You know, I completely missed that Terry was asking about her EAP clients so thanks for bringing it to my attention.
Unfortunately, whether you are working with an EAP or you are working with managed care, you typically sign a contract agreeing to certain conditions one of which is often, as in your case, not to charge for missed sessions. Claire, your policy of offering the same privileges, seems like a terrific way to get that “lost” session in. I wouldn’t have thought of that!
I think the more useful question might be around how to get the clients to keep from missing appointments in the first place. One of the techniques I use to help some of my clients (the ones that are at risk of bailing early) to stay engaged in counseling is to predict that they’ll leave early. I say something like “I just want to let you know that I know that lots of times clients in your situation aren’t really completely ready for counseling. I know that because they typically leave before our work is done or find some other way to self-sabotage themselves. I don’t know if that fits for you or not . . . . But, if it is true for you, I want you to know that I’ll understand perfectly and won’t take it personally. If it’s not the right time for you, it’s just not the right time. . . .”
What I’m doing here is talking about the elephant in the room i.e. his / her lack of motivation and setting up a double bind i.e. win / win in which, I hope, the client is more likely to complete his / her work with me.
If you try this out, I hope you’ll drop back in and let us know how it works for you. And, if you guys have other suggestions for Claire and Terry, I hope you’ll drop back in and share them with us all!
Claire, thanks again for taking time to comment here. It helps keep me on track as we build our online community and our bank of knowledge here at Private Practice from the Inside Out! I hope you’ll drop back in again soon – or sign up to receive email updates in your inbox!
As follow-up, it is true that you cannot charge EAP clients for No Show. Most EAP companies will support you having a cancellation policy and will usually count the No Show as one of their sessions. A few companies will pay the therapist. I state in my policy that if their insurance or EAP company does not allow me to charge them, I will not offer further appointments after two such occurrences. I do waive the policy if there is a death in the immediate family, if the roads are deemed impassable as in the case of severe weather, or if there is an emergency that warrants an immediate trip to the doctor.
I have decided to use the 48 hour policy. I sympathize with the person who is irritated with greater than 24 hours, however, in my practice it seems that the folks who are that worried about the policy are the worst offenders. I agree with the suggestion of talking with the therapist about her situation. I certainly have some folks who stay with me for years and never cancel. I suspect most therapists are likely to work something out in those situations. One thing I have done is to have two prices. If they cancel less than 48 hours, it is half the standard cancellation fee. If they cancel less than 24 hours, then it is the full fee. This seems to be working out fairly well.
Hi, Laura! Welcome back! I love your creativity in having two different fees for your cancellations! I hadn’t thought of that and haven’t heard of anyone else doing that either. Nice out of the box thinking!
As a private practitioner, you are able to charge whatever you deem to be fair. The only exceptions to this are if you have entered into legally binding contracts to that prohibit this. Assuming your contracts with EAPs does not conflict with your stated practice, your policy seems to be adequate.
I am a marriage and family therapist practicing in the inner city of NYC. I’m torn between 24 hours and 48 hours cancellation notice. Sometimes I have parents with very young children who get sick at the last minute resulting in cancellations, especially during the winter months or last minute daycare issues. What is a good way to address the cancellation policy during the 1st session with those who have young children and when they don’t abide by the policy?
Also, I have an office policy regarding pay the session fee at the begining of each session. My patients don’t follow this policy and i don’t know how to reinforce it after ts been discussed in the disclosure statement. I don’t have a receptionist. What are some ways you would reccomend that I address this issue with patients?
I hope you don’t mind, but as a new subsriber as I read the old blogs, I may have some questions.
Thanking you in advance,
Hi, Sherly! Welcome back to Private Practice from the Inside Out! I love it when my subscribers drop in with questions, suggestions, and brilliant ideas! That’s what I’m here for!
Concerning your cancellation policy . . . . First of all, there is not just one “right” way for a cancellation policy to be structured. In fact, I’ve been involved in a discussion on LinkedIn recently concerning cancellation policies and there are at least 15 different versions I’ve seen there! What is important is that you give some serious thought to what you want yours to be and that you be clear about sticking to it. The only difference between 24 and 48 hours is personal preference. I request 24 hours notice for the very reason that you state – things happen and my goal is not to get rich quick at my client’s expense. That 24 hour notice for me is about setting boundaries, being treated with respect, and not resenting my clients because they’ve stood me up.
My clients receive their paperwork to read over and complete before they ever arrive at their first appointment. The arrive with it read and completed. At our first session, I ask if they have any questions about any of the paperwork, answer their questions, and then address the different sections of the consent form. When I get to the section on cancellations I state . . . “I request that you give a minimum of 24 hours notice by phone when you need to cancel / reschedule an appointment. I will always support you to do what you need to do to take care of you and your family. However, barring life threatening emergencies, if you are unable to provide the 24 hours advance notice, you will be charged my full hourly fee of $100. In reality, I do waive my fees for sudden illness and / or a lack of childcare. I have never had a client abuse those exceptions. If I did, that would then become a clinical issue to be discussed and a business boundary to be enforced.
As for collecting your fees, I suggest that you walk into your waiting area or office to meet your client with your receipt pre-written as much as possible. Before you even sit down say “Let’s take care of your payment first so that we don’t have to cut off our work at the end to deal with money issues.” If you are working with brand new clients, they will assume this is just the way that you run your business. If you are changing this pattern with existing clients, then it’s perfectly OK to state “I’m changing a few things about the way I run my office. From now on, I’m going to start by taking care of your payment before we settle into our session. That will enable us to not have to stop in the middle of our work so soon.” By explaining this, your clients will feel taken care of . . . because you are doing this to protect your time together.
Let me know if these work for you, Sherly! And, I’m sure there are other subscribers out there who can offer different suggestions. All suggestions welcome here!
No-shows and last minute cancellations are the bane of all therapists. At first I was really nice about it “it’s okay! Things come up. Just give me more notice next time”. But then after repeated no shows I got fed up and decided to take action. I no longer take people with medicaid or medicare. That alone cut my cancellations in half. I then started a 24 hour cancellation policy except for emergencies. I noticed that the exception for emergencies thing didn’t cut down my no-shows because people would just make up excuses. Now my policy is $50 for late cancellations and $80 for no-shows. If they don’t pay it at the next session, they can’t see me anymore. No exceptions. I explain this in detail during the first appointment and have my voice mail say “If you are calling to cancel and are giving me less than 24 hours notice, I must remind you that you will be required to pay a $50 cancellation fee”. I also have form letters I mail (including another copy of my office policies) when people miss appointments, reminding them of the fee. Now I rarely get cancellations. It sounds mean, but you have to do this if you want to make a living. And if a client gets so mad about the cancellation fee that they don’t come back, then that is there decision. It’s better to get no-showers out of your schedule
Hi, Madea! It’s good to have your voice here! I can see that you’ve definitely taken charge of this issue in your practice! So glad it’s working for you!
I am curious about your statement that since you quit taking clients who have Medicaid and Medicare, you have noticed that you have half as many cancellations. I’m really surprised by that number. Do you (or anyone else) has any hunches about that?
Many offices such as optometrist and dentist call their patients the day before to remind them of appt.Can we legally offer this option and then say in a cancellation policy “You may be contacted 24 hours in advance and can cancel at that time.. If you choose not to receive a reminder call, then a $50.00 cancellation fee will be assessed? Any thought or feedback
Hi, Gail! It’s legal to call your clients assuming you have their permission to do so and you are observant of confidentiality. And, it’s certainly legal to have a cancellation policy that stipulates 24 hours notice (or any other time frame that you deem appropriate) is required. However, it is much simpler to say “If you are unable to give a full 24 hours notice, you will be charged for the time that was reserved for your appointment.”
I am not an attorney, but I do wonder if by stating “you may be contacted . . . ,” you may be taking the teeth out of this policy. After all, you haven’t committed to being responsible for calling 24 hours in advance but you have stated that you will be charging the client anyway for that appointment. If you are really attached to the language that you’ve suggested above, Gail, I would suggest you run this by an attorney to see if it is really accomplishing what you want.
Thanks for the input Tamara. Starting 2012, I plan to add a cancellation policy to my website and in writing.
Excellent plan, Gail! Happy to help!
Hello,
I would just like if any of you has a cancellation policy that also provide for when it’s the therapist who cancels less than 24 hours in advance.
And Tamara, what are your thoughts on the matter: should the therapist who cancels less than 24 hours in advance offer a free session, given that the client has also set aside that hour?
Hi, Lo! It’s funny that you should mention this. It’s not written in my cancellation policy but I do adhere to the same rules that my clients adhere to. Barring weather and emergencies, my clients are entitled to expect the same from me that I expect from them. If I stood them up or double booked an appointment, decided to stay home or take a trip, they can expect that they would receive financial “credit” for that mistake or last minute inconvenience. Absolutely!
Is that your policy or your therapist’s policy? As the employer, I would think that any client would expect / require no less.
Hi Tamara,
I respect that, it makes sense.
The reason why I was interested in the various cancellation policies is that my therapist recently cancelled a session at the last minute.
I was really upset so she decided to disclose the reason for her “emergency”, which was an event she could have planned in advance so as to give me reasonable notice.
I didn’t confront her on that as I wasn’t comfortable with her disclosure in the first place and I didn’t want to enter the details of it, but I do feel unjustly treated.
I am sure in the long run we will resolve this issue, but in the meantime I am glad to hear that other therapists treat their own cancellations with the same fairness as their patients’.
Thanks, Lo, for continuing this discussion here. I know that I’m not perfect and I don’t expect the professionals I hire or the clients who hire me to be perfect either. However, I do expect all of us to be responsible for the mistakes we make and to clean up our messes.
I do think that therapists and clients alike often forget that the client is the employer and the therapist is the employee. It would be wise for both to operate with the same understanding of the ground rules. It makes for a smoother process. So much of “success” in therapy is based on the actual relationship between the client and the relationship . . . . It’s often initially uncomfortable for a client to address the feelings that you describe – of being treated unreasonably, unfairly, or with disrespect. However, Lo, I would encourage you (and other clients) to take a look at what it is that makes you uncomfortable in broaching that topic with your therapist . . . .
In my experience, those unspoken topics are often the keys to unlocking the patterns that keep us stuck. By saying that “in the long run” you expect to resolve this issue, you obviously have worked to build trust in your relationship with your therapist. And, who knows . . . perhaps your therapist is part of our online community here, will read this discussion, and recognize her own impact on her clinical work with you!
Best wishes on your journey!
My therapist recently mentioned offhandly that she has a new cancellation policy. Four weeks vacation okay then any cancellations other than that have to be rescheduled. This doesn’t seem to offer me any hiatuses from therapy, coming less frequently for a while, etc. I understand her need for secure income, but i’ve never experienced this kind of set-up, and it feels like my needs are being subordinated to her finances. Am i offbase here?
Sjw – I’m not really sure what you mean . . . . The frequency at which you see your therapist should be based on your needs and is, ultimately, your decision. Many clients benefit from breaks in therapy . . . to practice or solidify the material they have been working on, to re-focus / re-identify / clarify priorities, etc.
Should your therapist disagree with that frequency, you should be able to have a conversation around the clinical reasons for that disagreement so that you and s/he both understand the costs / benefits from a break. The frequency you see a therapist should not be contingent upon your therapist’s needs – financial or otherwise. If I am understanding you correctly, I would suggest that you begin your next appointment with this very conversation. Perhaps there has been a misunderstanding?