Last week I told you about the $400 missed dental appointment fee that's made headlines. While most would agree that's excessive, lots of practices have policies designed to discourage no-shows.

This week, let's review some of the ways dentists handle patients who skip dental appointments.

A multi-tiered approach

Many dental practices treat the first missed appointment quite differently than the fifth. Some offices do not charge until the third missed appointment. Others charge an increasing amount for repeat offenders.

"After school appointments, Saturday appointments, and school vacation appointments are considered to be 'prime time appointments' and are in very high demand," read one pediatric dentist's appointment policies. "If a prime time appointment is missed we will no longer be able to schedule your child during that time."

And the rest of the family is at risk once one misses an appointment. "We reserve the right to cancel appointments for family members who have upcoming appointments, once a fee of $100 has been charged to another family member."

Other dental practices simply "fire" patients who have missed too many appointments, asking them not to return. (Not surprisingly, some patients become irate upon being fired.)

Raising prices

Some dentists find that a $20 or $40 missed appointment fee either doesn't cover their costs or doesn't prevent future missed appointments. As a result, more dentists are charging $75 for no-shows, and some charge up to $150.

Sometimes it isn't a flat fee, but related to the cost of dental work. "Our fee is 50% of the scheduled service," said one dental worker. "It has cut down on no-shows quite a bit, but it still happens occasionally." Other practices charge by the hour of missed appointment time.

Some practices even charge interest on missed appointment fees.

Patient contracts

The Internet is rife with inquiries from patients who don't want to pay their fee, asking questions like, "Can my dentist charge me for missing an appointment if I didn't even know there was a fee?"

Some practices get around this possible objection by having all patients sign an actual contract outlining their financial policies. "A new patient fills out paperwork," said one dentist office. "Like with any contract, it clearly states that they understand that if they do not give the required 3 business days notice, there will be a charge of $50."

Other practices simply post their policies on their dental website and/or in their waiting room.

Patients just don't want to pay

One patient offered this advice to others looking to get out of paying fees: "Whenever I get charged some sort of 'late fee' for a utility bill, I just call and ask if they would consider redacting the charge. I've never had anyone say no."

"It also is with great discretion that we dole out cancellation charges," said one dentist. "We know that by law they are uncollectable, but it prevents the bad apples from making future appointments and wasting more of our time."

Cutting down on missed appointments

Calling patients to remind them of upcoming appointments can dramatically reduce no-shows. Multiple calls can be time-consuming but effective.

"We call our patients who have upcoming appointments 30 days prior to the appointed date to allow them ample time to make other arrangements," said one practice. "We call again 2 weeks before the appointment, 5 days before the appointment and again 24 hours before the appointment. It takes a long time to make these calls but we find it is worth it in the long run because we usually see about 200 patients per week and have approximately 10 no shows or late cancels out of that number."

What’s your policy?

How do you maintain profitability without alienating patients who have missed appointments? If you haven't yet taken our survey on missed appointment policies, I encourage you to do so now!