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An Alternative to Missed Appointment Fees

An Alternative to Missed Appointment Fees

Any kind of medical or dental practice goes through great lengths to keep patients from missing or canceling appointments. Signs are posted in reception areas and patients are informed of office policies. We try and think of every legal avenue to keep our schedules full and still patients find a way to leave holes in our schedules – even if we tell them it will cost money to miss their appointments.

What happens when you tell them they are going to be charged? How often have you actually collected a missed appointment fee? Is it really worth spending all that administrative time trying to collect it when you didn’t even produce anything?

Unfortunately, missed and cancelled appointments are unavoidable in the dental practice, but there are ways to significantly reduce them:

First contact: When a new patient calls you have a lot of information to get. Patient demographics, insurance information, contact information and somehow you have to squeeze in a cancellation policy? You shouldn’t rush a new patient call under any circumstances, but once you’ve established a relationship with the patient, feel free to ask them to call you in the event something comes up before their appointment. Explain that you have reserved time on the hygienist or doctor’s schedule so they will be given individual attention by the staff and ask, as a favor, for a call at least two business days in advance if they have an emergency, and have to reschedule. Saying this will hopefully imply an “emergency” is the only acceptable time that they can miss an appointment and saying two business days is intended to give the office the opportunity to fill the new opening.

When they cancel: We’ve now gotten to the point at which a patient actually calls to cancel. I’ll never forget the time a mother of 5 called to let me know she was running late for all 5 hygiene appointments and in the background I could hear the voice at the drive thru asking if her order was complete. We know people lie but we cannot say anything. The best line of defense is to kill them with concern. The moment you portray frustration the patient becomes defensive and when you throw out a cancellation fee it elevates the situation. You can mention the fee but in a way that is helpful to the patient. For example: “This must be a tough day for you so we can waive the cancellation fee for you”.

It is crucial to document the details of this conversation in case it happens again. Have an office protocol that dictates where this note goes and have a step by step approach for the staff when a patient does call to cancel. In the event of a short-notice opening, utilize your practice management software’s “ASAP” list in conjunction with your patient communication program to instantly reach out to others waiting for a sooner appointment. If you don’t have this technology yet, be sure to have an easily accessible list of patients you can refer to.

The repeat offenders: This is where things get tricky and I recommend practicing on co-workers. The second time a patient cancels last minute you still want to have the same level of concern as the first time. Don’t be afraid to mention the circumstances of first time if the excuse is related. Try and be light-hearted and offer to try to schedule one more time: “Oh no, I’m so sorry this happened to you again. Let’s see if we can try one more time to find a convenient time”. The words “one more time” are intended to let the patient know you are paying attention to the frequency of the occurrence and don’t expect it to happen again. If it happens a third time then this is where you enforce “same day only” status. You can carefully say: “I’m so sorry this keeps happening to you. We think it would be best to hold off on rescheduling at the moment until things calm down for you. I’m going to put you on a short-call list.” You can go on to explain they are welcome to call the morning of their next open day.

The objective of this process is to maintain a relationship that otherwise could easily be severed by piling on cancellation fees. I’ve written off countless fees when going through accounts receivable because the patient left the practice and never came back after being “punished”. Changing the culture of how you handle cancellations (and no-shows) will make the situation less frustrating for you and your patients. I hope you won’t have to use this advice very often but in case you do, remember that concern and firmness are necessary in these situations.

Bridget Fay, BBA
Senior Consultant
Odyssey Management


  1. Excellent advise. Ive used this approach for years.

    • We have used this approach and IT WORKS! We usually say…..Wow, I have never met someone as busy as you are and then the rest of what you have in the article. It makes them think. We had a few of those patients and we have now trained them, they know they need to be here when they have a scheduled appointment!

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