Use a series of letters to explain the consequences of missed appointments Make all of your patients aware of your financial policy, including charges for missed appointments. MISSED-APPOINTMENT POLICY SAMPLE WARNING FORM
Use this sample written policy and the two sample letters below to get yourself started on your office's own policy to ensure your practice isn't losing time and money.
Purpose: To notify patients of a possible financial penalty for failure to cancel a scheduled appointment. Missed appointments have an impact on the physician's schedule and can also pose a health risk to the patient. When a patient does not show up for an appointment or cancels an appointment on short notice, we will make a note in his/her medical record.
Failure to give 24-hour notice of cancellation of an appointment or not showing up for an appointment can result in a charge of $25.00 on your account. This charge is noncovered by your insurance company and is your responsibility. Failure to pay a no-show fee will be treated the same as our policy on unpaid balances and subject to reporting to a collection agency if unpaid.
Medical care will not be withheld for a medical emergency. Not showing up for three appointments can result in the patient's discharge from the practice, per the physician's discretion.
Notification: Patients may be warned that they have violated the policy by phone or in letter form.
Dear ______________,
It has been noted in your chart that you have missed at least two scheduled appointments with our office. We ask you to show consideration by notifying our office at least 24 hours in advance if you are unable to keep an appointment. We would like to have the option to offer that appointment to another patient who needs to see the doctor.
This letter serves as notice that if you fail to give us a 24-hour notice of cancellation in the future, there will be a $25.00 cancellation fee billed to your account and is noncovered by your insurance. You will bear complete financial responsibility for this fee. Repeatedly missed appointments may result in dismissal from our practice.
We are concerned that you may not be receiving necessary medical care because of these missed appointments. Please call if you are still experiencing problems. We value you as a patient.
SAMPLE DISMISSAL FORM
Dear ______________,
As a result of at least three or more missed appointments without prior notification, our practice is terminating you as a patient.
We respectfully advise that you seek the service of another physician. We will be happy to provide a copy of your medical record with a properly signed authorization to another physician of your choosing. We will continue to see you on an emergency basis for thirty (30) days from the date of this letter. As of [fill in date] you will be officially dismissed from our practice. You may wish to consult with your insurance plan for participating providers or the local Yellow Pages under Physicians and Surgeons to select a new provider.
You may also wish to contact the local medical society at [insert phone number] to assist you with the selection of a new physician.