Charging No-Show Patients a No-Show Fee? Please!!!!

[Danni R.]

Great conversation... giving pros and cons. It is, and remains a hotly debated subject and I enjoy hearing different sides. In the end, I think we can analyze and pull it apart until the cows come home and still find that no one is right, no one is wrong.

On another forum a lady (Jeanie) tells me that:

"While I agree that most... make it very clear about the no show charges... my own personal opinion is that it is a very one sided deal. When I make an appointment and make every effort to be there ahead of the appointment time and then find myself waiting for 30 mins to an hour past that time to be seen, I can understand the frustration of the patient... It can be very frustrating, and for working patients results in loss of income and productivity when appointment times are not honored. Another issue I have run into with my elderly mother is she had one physician who if she was even 5 min late for her appointment refused to see her. Physicians go to school for many years and offer a much needed service to the public and deserve for their patients to show respect for their schedule; however, if they did not overbook, double book, and treat their offices like an assembly line they might find they... "

My point of view is that, we must remember that we are talking about a profession that largely deals with sick, handicapped and needy people, but not only that,  it is also a profession that deals with life affecting lives. People aren't perfect and life isn't perfect. It tends to throw a few monkey wrenches along the way. No one can control people and life. As a successful business owner I've learned to cut my losses, often in the Thousands, along the way and move on, using my time to make more money. The IRS takes a good chunk of it back - not fair - either.

My main argument remains that if the missed appointment gap, which according to typical scheduling should not be more than 20 minutes was used in an efficient, meaningful manner, such as addressing notes attached to a pile of patient charts that need to be responded to, important telephone call returned, filled by a sick-call, or walk-in patient, or used to catch up with already waiting patients to be seen, then how does this justify assessing a no-show fee of up to $125 dollars.  The business is running and making money. Should restaurants charge no-sow fees? Hair dressers? Plummers? Web designers? How about Walmart? And should we begin to sue each other for losses that are bound to time, tying up the courts?  Should courts asses a no-show fee? I just don't see it.

[Steve Verno]

Danni

Obviously circumstances happen and should be looked at closely.  There are some "excuse" patients.  They make appointments, and never show.  There is always an excuse with them.  One woman who did this with my doctor had 5 mothers that passed away, I wont tell you how many teeth she had to have removed at the dentist

One practice I worked at had an obese man who constantly no showed.  He also never called to change the appointment.  One day he dropped dead.  His relatives sued the doctor.  In court. the lawyer said over and over again, that the doctor didnt do enough to get the patient to come back in.  The verdict was $3,000,000 against the doctor. The fact that the man was severely obese, developed cardiac problems due to his obesity and lifestyle wasnt taken into consideration.  The didnt do enough defense blamed the doctor.   He developed a no show policy, sent letters to the patient, all by certified mail/return receipt.  He had to hire a staff member to actually go to the patient's house.  Many addresses found were bogus. The bogus addresses were brought to the doctor's lawyer, so the lawyer sent the patient-provider termination letters.   The cost of the certified mails and extra staff member operating costs were passed onto the patient in the form of higher charges for a visit.  So, after, the doctor couldn't be accused of not doing enough.  

[Danni R.]

I have heard many stories about situations where a patient fully intended to come to their doctors appointment until the unexpected happened, for example, one patient got into her car to get going and the battery was dead. Her medical office's cancellation policy was 48 hours. She went back into her house to make some calls to see if she could find a ride. Taxi was out of the question. She did not find a ride and so she called the office to let them know she wasn't able to make it. The medical assistant took the message and was told she's all set. A new appointment was given. A few days later she received her bill for no-show.

Another patient couldn't make it to a Monday morning appointment. Her medical office had a 24 hour cancellation policy. She intended to call the doctor's office right after church, but then became side tracked. When she suddenly remembered that she still needed to call the doctor to cancel it was already 6 PM Sunday evening. She assumed that no one would answer the phone this late on a Sunday she decided to call first thing Monday morning. Some time after that she received a no-show bill in the mail.

Another patient had to attend a funeral in a different state. The whole thing was upsetting and traveling exhausting. He completely forgot he had an appointment during the week that he was gone. Once back home he called the doctor, apologized for completely forgetting about the appointment and explained the reasons. The doctor was sympathetic and assured him he'd waive their no-show fee. Some time after this conversation he receive a bill from the doctor, charging a $75 no-show fee.

I suggested he'd call the office but ask for their billing department directly, rather than speaking to the front desk staff, or doctor again. Typically, it's not the doctor sending the bills but is handled by the medical office admin or billing office. The doctor's billing department may be entirely separate from the office, or they may have an electronic scheduling system which marks "no shows" and the doctor may not have marked it canceled.  

[Steve Verno]

Danni

A doctors time is very valuable considering how many patients can be seen in one day.  The doctor not only treats the patients who walk into their office, they also treat patients who have been admitted to the hospital.  Charging a patient for not showing up is acceptable, only if the patient is aware of the charge.  Ive been a no show myself, but it wasnt my fault.  When I arrived for my appointment, 1/2 hour before the appointment time, there was a notice on the door that they moved.  They didnt inform me of this.  I tried to call them and got their answering service.  They never passed the message onto the doctor. The doctor tried to charge me but I fought back and won, the doctor terminated the patient-provider relationship.    Sometimes things do happen and each circumstance should be looked into before charging a no show fee.  Again, the patient must always be aware of any charges they are responsible to pay.  State laws may mandate that a patient cannot be charged for anything that they have not been made aware of.  One of my doctors has a huge sign posted that the patient will be charged for a missed appointment.  With this doctor, I dont miss anything.  I like him, he gives a d*mn about his patients.  He bills correctly and works with every patient who needs help, medically and financially.  There may be other circumstances where a patient may not be charged for a no show appointment. The doctor may be contracted with ABC Insurance and that contract may not allow no show billing of the patient.  The same may be for Medicaid patients or other situations as defined under applicable State law.  You cant bill the insurance company for the no show appointment.  There is no CPT code, right now, for a no show appointment and you cant bill an insurance company for an office visit code (992XX).   

Some patients are sueing doctors, successully, when the patient has an appointment, and waits for an unreasonable time to be seen.  i dont sue, i walk out and I fire the doctor.  My time is also valuable and there are other doctors out there that I can give my business to.  If you take a step back, ( I didnt look at the video yet), that time is income to the doctor. 

Look at other businesses, you want to fly to Orlando and you dont show for the flight.  You most likely wont get your money back.  The seat was there and it wasnt the airlines fault that you missed the flight.  If you make a reservation with a hotel and you dont show, you are charged for the room.  We cant forget that the doctor is a business.  This is where the doctor develops his practice financial plan.  The plan details no show charges and the patient is informed of the plan and is provided with a copy, so the patient cant say, I didnt know. 

[Danni R.]

I was watching this video clip with great interest. Charging no-show fees has always been a hotly debated and carefully contemplated topic even a decade ago when I was working as a certified medical assistant. So, I was curious what the video might tell me that's (not) new...

<a href="http://www.youtube.com/watch?v=0j5AJqwRGEo" target="_blank">http://www.youtube.com/watch?v=0j5AJqwRGEo</a>

In watching the video I have to say I completely disagree! While the author says that the answer to charging patients for no-shows is a resounding yes to cover losses and as a form of negative reinforcement to teach patients NOT to do that, my response is a resounding no. Don't charge. It will simply alienate patients and at minimum, leave a sour taste in their mouth. Honest mistakes happen. We do get stuck in traffic, unforeseen things do come up and we get side-tracked, or we simply forget. Most patients intend to come as scheduled and many no-shows are honest mistakes. Even I, as a patient, have found myself caught up in unforeseen situations and I wound up calling the very last minute that I won't make it.

In my role as a medical assistant, I have NEVER!!!!! I say NEEEEEE-VER... seen a doctor sit and twiddle his/her thumbs to bridge the time gap from a no-show. You have to understand, appointments were scheduled tight, with so many patients per 15 or 20 minute time slots and we also took into consideration that some patients might go over their allotted time in the exam room, while others might be right on the mark, or take up less time, so that in the end it will all even out. No-show slots were a welcome break to ask the doctor to address phone messages attached to patient charts that had come in during the day so we could call the patients back with the doctor's instructions; furthermore gaps were filled with last minute sick calls and in the end they were a welcome brake to catch up with the daily grind. As the day progressed the doctor inadvertently almost always fell behind and patients who arrived on time for their appointment wound up sitting in the waiting room over 30 minutes, or more, just to be seen. A no-show gave us a little breathing room and in the end as the day progressed and closing time finally approached everybody was seen and cared for.

Knowing both sides of the coin, here is where I stand on this topic: if the doctor charges patients up to $125  for no-show then patients should charge the doctor the same amount for the time they are being kept in the waiting room beyond the scheduled appointment time. So, please!!!!! Let's just call it even, a win-win situation and give and take relationship between doctor and patient.