Handling No-Show Fees In A Play Therapy Practice

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Private Practice cancellation policies

Are you unsure about how to handle late cancellations or no-show clients in your Play Therapy Practice? Does your policy change if you are working with children versus adults? Consider the three most common office polices for no-shows and determine which one is best for you.

The 3 Types of No-Show Policies:

  • Strict No-Show Fees: These clinicians charge every client no matter what the reason and have a credit card on file. Clients agree to this policy during the informed consent process and are aware of the fees and policies. Clinicians charges range from the full session fee to a portion of the full fee.
  • Flexible No-Show Fees: These clinicians typically wait until the next scheduled session to discuss the reason for the late cancellation or the missed appointment. If it was an emergency or serious illness, the fee may be waived. If not, the clinican bills the client for the full session fee or a portion of the fee.
  • No Fees: These clinicans typically are prohibited from charging fees for missed appointments due to insurance regulations or court mandated programs. For example, many Employee Assistance Programs or government insurance panels strictly prohibit charging fees to clients for missed appointments.

The Importance of Written No-Show Policies:

Whatever your policy, it is important to have it well thought out and clearly written in your informed consent paperwork. If you decide to make any changes to your no-show policy, make sure you update your paperwork for new clients and have old clients sign an updated consent form (or addendum acknowledging the change).

The Impact of No Show Fees on Client Retention:

There should not be a significant impact on client retention regardless of your policy IF you have clearly outlined it up front with all new clients. Clients who are not happy with the idea of being charged for all missed appointments, regardless of the reason, may decide after the first visit to choose another provider. Ultimately, this is getting you closer to your ideal client that doesn’t mind this policy.

As a clinician, if you are bothered by the idea that you can not charge for no-shows, you will avoid Employee Assistance Programs and government insurance panels. Again, this drives your Practice in the direction that best suits your personality and clinical style.

Considerations for Adult vs. Child Clients:

It is much easier to charge for missed appointments when you are dealing with adults. They are usually motivated to come to therapy and directly benefit from your services. With children, there are many more variables. They are sick more often. They get hurt more often. They have emergencies more often. Do you want the parents to bring you a sick kid just to avoid a fee? I don’t. It just puts my other clients at risk and compounds the problem. Or, it makes me sick and then I have to cancel a whole day of clients to recover from my own illness, which is worse.

The Impact of No Show Policies On Clinician Satisfaction:

The more your policies align with your own personal values, the happier you will be in Private Practice. For me personally, I take commercial insurance and Medicaid products as well as Employee Assistance Programs.

I am able to charge no-show fees for some, but not all of my clients. I decided early on that I would not charge any client for late cancellations or no show fees. Although my informed consent paperwork still says I reserve the right to do so, when allowed by insurance contacts. It didn’t seem fair to charge one client and not another for the exact same excuse. So, I ditched the no show fees.

I also have three kids and they get sick. I feel like my clients understand that I might sometimes have to cancel on them on short notice. We just “get it”. Life happens with children. It is not because they are not motivated or do not value my time. It is because, sometimes, things just don’t work out. When parents understand that I can see it from their point of view, it builds trust. So, we both work hard to make it to appointments and we both understand if something goes wrong.

Other clinicians, however, feel resentful of the lost wages. They are angry about the fact that they did not have the opportunity to offer that slot to another person on the waiting list. Those clinicians should keep their strict policies, because it will allow them to do better work in the long run. It aligns with their personal values and it is good financial business.

Alternatives to No Show Fees:

Instead, I institute a very strict referral policy. If a client doesn’t show for a scheduled appointment, they are sent a “warning letter”. After another consecutive missed appointment, they are referred to another provider. If they have three missed appointments anytime during a three month period, they are referred to another provider.

I gratefully use the downtime from those missed appointments to shop online, call insurance companies, write blog posts, or just be creative about other opportunities for my business. Sometimes, it is during this unexpected downtimes (like right now!) that I do good work.


Jennifer Taylor, LCSW, RPT is an experienced child and family therapist and public speaker who specializes in trauma, ADHD, and conduct problems. Discover more about her diverse clinical background and family. Reach out to Jennifer with questions or comments by emailing at info@jentaylorplaytherapy.com