Front Desk Playbook

Should I charge the no show fee?

Yes, if your policy says so and they agreed to it. A policy you never enforce teaches clients it isn't real. Say it kindly, say it once and offer the next booking.

When they simply didn't show

Hi Jordan, we missed you today at 2:00. As our cancellation policy says, a missed appointment is charged at the full price, so you'll see that on your card. I'd love to get you back in. Want me to send a few open times?

When they had a good reason

Decide your rule before it happens, so you aren't weighing each excuse. A first time grace written into your policy does this for you. It's rare: only 2 of 153 practices in our policy study offered one in writing, so it can set you apart.

Waiving it once

Hi Jordan, I'm sorry about your day. I've waived the late cancellation charge this time. Just so you know, next time our 24 hour policy will apply. Want to rebook now?

Charging it anyway

Hi Jordan, I'm sorry to hear that, and I hope everything is OK. Our policy does apply to late changes, so the charge will go through. When you're ready, I'll find you a time that works.

Is it fair to charge a no show fee?

Yes, with notice. The American Medical Association's ethics code lists fees for missed appointments as acceptable when patients are told the policy in advance and the fee is reasonable. Medicare lets providers charge patients for missed appointments if the policy and the amount are the same for every patient, Medicare or not, and the fee is never billed to Medicare. Medicaid is the exception: federal policy bars charging Medicaid only patients for missed or cancelled visits. This isn't legal advice, so check your state's rules and your payer contracts.

How to start enforcing a policy you never enforced

Start fresh with a short notice to every client, then apply it from that date. Nobody is surprised, and you never have to charge a fee you didn't announce.

A quick note: starting next month we'll be applying our cancellation policy. Changes need 24 hours notice, and late changes and missed visits are charged. Thanks for helping us keep times open for everyone.

Questions owners ask

Should I charge the fee if they had a good reason?

One fair approach is to waive it once and say so, then charge the next time. Writing a one time grace into your policy makes this easy, because you're following your own rule instead of judging their reason.

What if they get angry?

Stay with the policy they agreed to and keep it short. Thank them, restate the policy once and offer to book their next visit.

Sources

  1. Code of Medical Ethics Opinion 11.3.2: Fees for nonclinical and administrative services American Medical Association Checked
  2. MLN Matters MM5613: Charges for Missed Appointments Centers for Medicare and Medicaid Services Checked
  3. Policy statement: charging members for missed appointments Colorado Department of Health Care Policy and Financing Checked

Updated 3 November 2026