Missed Sessions: What Does Being Too Nice Cost You?
by Barbara Griswold, LMFT (April 21, 2016)
In my consultations with therapists nationwide, we strategize on how to keep more of their hard-earned money — without working harder. While there are many factors we can’t control, I am struck by how often these therapists are leaving thousands of dollars on the table each year due to one thing they can control: their cancellation policy.
It’s true, insurance generally won’t cover missed/late-cancelled sessions, and shouldn’t be billed for them. EAPs also don’t usually allow you to charge for a no-show, or it may count as one session (some EAPs will pay for part or all of the first no-show — check your contract).
However, if you are in-network with the client’s insurance, you can usually charge the client for a missed or late-cancelled session. You may only charge your insurance session rate, and you must have gotten the client to sign your cancellation policy in advance. Out-of-network therapists can charge clients up to their full fee.
So why aren’t we charging clients regularly for missed sessions? We are compassionate — we know clients are busy, and things come up. We want to be seen as kind and flexible. We feel guilty charging for a session when no service was provided. And while we spend our days encouraging clients to express feelings, the truth is we really don’t want them to be mad at us, and maybe even terminate.
But would we question an airline that charged for a missed flight? A hotel that charged for a late-cancelled reservation? So why don’t we think of a missed therapy session in the same way? In all cases, the client’s late cancel means the business doesn’t have time to fill the reserved space, and loses money.
And this can add up to thousands of dollars in lost income. Do the math: Imagine you started collecting on two missed sessions each week, then multiply that income by 52 weeks/year. That’s about how much more you’d be making than you made last year.
I challenge you today to stop paying for the chaos in your clients’ lives. Each week, you will have a certain amount of income lost due to sudden emergencies and illnesses (yours or theirs) or unfilled hours, and you don’t need to add to that. Also, a firm cancellation policy serves a therapeutic goal, by challenging clients to make therapy (and themselves) a priority.
5 Tips to Earn More Without Getting More Clients:
- Have a clear cancellation policy and communicate it to clients, both verbally and in your treatment contract. Identify exactly what the missed session fee will be, and if you are in- network, that they must pay more than a copayment.
- Enforce your policy — consistently. Otherwise, as with inconsistent discipline in parenting, we encourage boundry testing by clients.
- Know your exceptions. I don’t charge when the client couldn’t cancel in advance (ex. emergency or waking up sick). I DO charge for work conflicts because I don’t want to make it easy for a client to put work before self-care.
- Charge the full amount you would have collected for the session (if you are in-network with their plan, charge the full insurance contracted rate). Otherwise, why are you taking a loss for their missed session?
- Don’t allow a session to be rescheduled later in the week for free. The client is essentially taking two of your slots and paying for one. Also, it sets up an expectation for the future.
Some Other Tips:
- When a client late-cancels, remind them: Say “I’m so sorry — I know you’re busy, and I hate to charge in full for a session when you won’t get the benefit. So if there is any way you can make it I hope you can work it out.” I can’t tell you how often they show up.
- If they are unable to come due to work: “I hate to charge you, but I can give you an invoice for the missed session and you might be able to get your company to reimburse you.”
- Many therapists take down credit card information at the intake so they can charge for missed sessions as they occur.