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!

Many dentists charge patients missed appointment fees. Typically, these fees tend to be about $25-50 per appointment. But there's a lot more variation than you might expect!

A recent survey we conducted showed that an average of 1 in 10 patients is a no-show. That's a 10% reduction in dental practice profitability, and a serious dental management issue.

The $400 missed appointment fee

Roland Ikporo's son got a toothache last month, but their family dentist was closed. So he took his son instead to Calgary's Expressions Dental clinic.

The dentist there conducted an exam and took x-rays at a cost of $150. He told Ikporo that his son needed 4 teeth removed right away. So Ikporo made another appointment for two days later.

But within an hour, Ikporo cancelled the appointment, realizing that his general dentist would be cheaper. (While Expressions Dental would charge $1,700 to remove the four teeth, the dental work was only $800 from their regular dentist.)

Though called the dentist office to cancel the appointment less than an hour after he made it, his Visa was billed an additional $400 missed dentist appointment fee.

Ikporo had in fact signed a consent form that explained the clinic's cancellation policy: give 72 hours notice or be charged $200 per hour of missed appointment time. So by booking an appointment less than 3 days in the future, Ikporo had no ability to cancel.

Angry, Ikporo has registered a complaint with the Alberta Dental Association and College. They are now investigating.

Just an observation: Even if he pays the $400 fee, Ikporo will still have saved money by having his family dentist perform the extractions… The general dentist's $800 fee plus the $400 cancellation charge is still significantly less than the $1,700 quoted by the dental clinic.

What’s your policy?

Many dentists find that a $20 cancellation charge just doesn't get the job done. How does your practice handle no-shows?

Read more: Father angry over $400 dentist cancellation charge