Dental Management Survey: How Do You Handle Missed Appointments?

Charging for missed dental apointmentsWhen patients miss appointments, it affects dental practice revenue.

If it happens too often, it can turn into a dental practice management nightmare.

“In this day and age with e-mail, texting, cell phones, answering machines, Smile Reminders, etc., etc. There is no excuse for people to not show up for their dental or medical appointments or call to let the offices know they are running late or can’t make it. Its just pure laziness or lack of common courtesy.” Ohio prosthodontist

There are practice management tactics dentists can use to keep this problem from getting out of hand and ruining their practice. But do dentists use them?

In this dental survey, we report on how dentists handle patients who don’t show up.

Fees for missing dental appointments

When asked if they charge patients for missed appointments, 67% of our survey respondents said Yes – 28% charge a fee after the second missed appointment; 39% after the third miss.

One-third of our surveyed dentists said they don’t charge a penalty fee at all.

Chart: Do dentists charge for missed appointments?

Dentists charged patients between $25 and $100 for missing an appointment, with a $50 fee the most common.

“Our policy is a $50.00 no show charge after your 3rd no show appointment. We have done this only a few times. In the past when we tried it our patients threw a fit and a lot of times the charge was removed. How do we know if patient has a real emergency or creates an excuse? We try to emphasis that these are important appointments.” Missouri dentist

“We tried have chronic offenders pay a $50 booking fee before scheduling, this would be applied to the day’s fees or forfeited if the patient failed to show up. However the front desk staff was not consistent in enforcing it ON THE SAME PATIENT!!!” North Carolina dentist

Letting go of patients who miss too many dental appointments

Dentists don’t like to lose patients, under any circumstance.

But 68% of dentists in our survey said they will ‘fire’ patients who miss too many appointment: 5% after a patient misses 2 appointments; 37% after 3 misses; and 26% only after 4 or more misses.

Some dentists said they will never ‘fire’ a patient (5%), and 27% said it rarely, if ever, happens.

Chart: Do dentists 'fire' patients who miss appointments?

“Try to dismiss patient after 2 no-shows, but the situation can vary depending on the particular relationship of the patient with the practice.” Canadian dentist

“I’d really love to find something that works– While most of our patients come regularly, it seems that in the past years, it is more challenging to keep patients compliant with appointments. If we charge, we just get patients mad and they leave with the charge on the books.” California dentist

“Although I don’t charge or fire patients for missed appointments it seems to be a repeating problem and I lose a lot of potential income; and the time can never be recouped.” Texas pediatric dentist

Here are a few dental management policy recommendations that are working:

“We try to figure out what’s getting in the way of their keeping [appointments], and if problems continue, we either put them on a “quick call” list, have them financially guarantee a reserved appt, or dismiss them.” New Hampshire dentist

“It is difficult to collect missed appointment fees. We just give them 3 chances and then will not make another appointment unless there is one available the day they call. If they miss one of those, they are fired for good.” Texas dentist

“If you charge them, they will walk rather than pay. So for unreliable patients, demand a “deposit” before putting them on the books. Tell them they will forfeit it if they miss, and have to pay another deposit. I have never had a patient miss an appointment when they had a $75 deposit on the line.” Georgia general dentist

“A missed appointment cannot be rescheduled within 2 weeks of the rescheduling call. This serves as a reminder that missing an appointment does affect other people besides the patient, allows time to schedule other patients in more convenient time slots and serves as a minor ‘penalty’ for missed appointments. If a patient misses 2-3 appointments, they are not permitted to schedule further than 1 day in advance to limit the amount of forgetting appointments. Patients missing further appointments are dismissed from the practice at the doctor’s discretion.” Indiana dentist

“We charge the people that we want to leave the practice.” Minnesota dentist

What’s your dental practice management policy for patients who miss appointments?

Dentist Missed Appointment Policies

Dentist missed appointment feesLast 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!

Dental Patients Skip Hygiene Appointments the Most

Dental Patients Skip Hygiene Appointments the Most GraphDentists report that hygienist appointments are missed an average of 13% of the time, a survey by The Wealthy Dentist reveals, indicating that dental patients don’t seem to value dental hygiene appointments as much as they should.

Whereas regular appointments with the dentist are only missed 9% of the time, an indication that dental patients tend to respect their appointments more when a dentist is involved.

Rural dental patients showed the most respect for hygienists with dentists reporting only 3% of appointments missed, compared with suburban dentists who reported the highest percentages of hygiene patient no-shows.

Percentage of missed dental appointments graph

The Wealthy Dentist survey revealed that all dental patients prefer to see their dentist with suburban, urban, and rural dentists all reporting low percentages of dental patient no-shows when dental appointments included a consultation with a dentist.

Here’s what dentists had to say about how they handle missed appointments —

“We usually do not charge them for the first offense, but call them to reschedule, and tell them if they miss again, we will have to charge them then.” (Illinois dentist)

“We don’t schedule patients after 2 missed appointments.” (Texas dentist)

“After 3 broken appointments, we put the patient on our VIP list where they can only get an appointment the day that they call if we have one available.” (Alabama dentist)

“We call them immediately to find out why they have missed the appointment. We educate them as to why it is crucial to keep their appointments. Not to mention that we have other patients waiting to be seen in that time slot if they had called and given enough notice. We’ll fire the patient after 3 ‘strikes’ if there is a pattern.” (General dentist)

“It’s a big challenge. I wish I had a great answer. We have a written policy in our newsletter to call at 10 minutes into the appt. We then send a letter. The first one is a warning — free — then a charge.  We hear all the excuses imaginable, people less respectful than 30 years ago…” (Urban dentist)

“When they miss one appointment we immediately give them a friendly reminder about our broken appointment policy. We use Smile Reminders (text, e-mail, and phone) to remind our patients about their appointments 2 weeks, a few days, and the day before their appointment. This has greatly reduced our no shows to about 5% and also gives us time to fill their appointment if they have to move it. We are extremely happy with our low percentage of no-shows!” (Ohio prosthodontist)

“We made them prepay for future appointments and/or put them in a phantom column where they really have no time reserved. If they show up, we hope someone else doesn’t show up so we have time to work on them.” (Louisiana dentist)

“Try to reschedule them when they call. If not, have a list of unscheduled appointments to work from to fill empty appointment times.” (Connecticut dentist)

“We charge $50.00.” (California dentist)

Dentists, what has been you experience with missed dental appointments and how do you handle it?

Some Dentists Fire Patients After Missed Appointments

Some Dentists Fire Patients After Appointment No-Shows36% of dentists don’t charge for missed dental appointments — no matter how many times a patient is a “no-show.”

Only 5% charge a fee for the first offense, while 39% charge a fee after the second missed appointment. 20% of dentists charge after the 3rd missed appointment.

With the current economic conditions, The Wealthy Dentist decided to ask dentists if they have been charging for missed appointments.

Boston’s Pilgrim Hospital is in the news this week for reveling that in the first 10 months of 2011 patients failed to attend almost 17,000 appointments. Thats about 49 missed medical appointments for every day of the year.

“Time is money!” complained one dentist, and he is right. A missed appointment is an appointment that can be filled by other patients. Missed appointment fees ranged from $25.00 to $150.00. The average fee is $55.00.

In this survey, 42% of dentists said they rarely or never fire patients, 34% will fire a patient after the third missed appointment, and another 24% sometimes fire patients, but they have more than three chances.

The following dentists’ comments were selected to share how dentists are handling missed appointments —

Pre-paying is popular …

“We ask the patient to pre-pay for future appointments.” (Illinois dentist)

“Repeat offenders are put on ‘probation’ where they must pre-pay (the full price, non-refundable) before we will schedule them again. This way we don’t ‘fire’ them, they either pre-pay or leave the practice. They are usually on ‘probation’ until they consistently show up.” (Kentucky dentist)

“We have them pay before the appointment and if they break the appointment, the fee is deducted from their account.” (Missouri dentist)

After three missed appts we will not reschedule unless they prepay in full for whatever the appointment is for. It works great. We have a great practice and people know the value that they receive here.” (Colorado dentist)

“We ask the patients who no show for 2 appts or more to prepay for further visits.” (General dentist)

“We just charge them little more when they come next. Also if they are entitled for any offers or discounts don’t give them that.” (General dentist)

Confirming helps …

“Confirm. Confirm. Confirm.” (General dentist)

“Have your patients give you the cell number where they receive texts and text them their appointment. Works like a charm.” (California dentist)

“We confirm by phone, email and text message.” (General dentist)

“We double book or call patient the morning of appointment.” (California dentist)

“We send a sms reminder the day before the scheduled appointment.” (General dentist)

Same day or on-call appointments only …

“After the second time we choose the option of putting the patient on our short call list only.” (Georgia dentist)

“We don’t give 3rd time offenders the opportunity to schedule in advance. We put them in our ‘Short Notice Club’ and call them when we have an opening or they can call to see if they can get in that day.” (Oklahoma dentist)

“After 3 missed, the patient must call on a day they would like to come in and see if there is an appointment available.” (Pennsylvania dentist)

“We don’t “fire” them but put them on a VIP list where we call them when we have a same day appointment available.” (New Hampshire dentist)

Fire them …

“My letter to the patient who I am dismissing is actually very nice. It states that our priorities do not match and that they would be better served by another dentist and to please let us know where to forward their records. A lot of times, the patient begs us to let them come back to the practice and they become our best patients ever about being there for their appointments even in bad weather, etc.!” (Alabama dentist)

“We send three letters and then dismiss patient with a 30 day emergency window so they have ample time to find a new dentist that will be more conducive to their schedule.” (Missouri dentist)

You must get rid of them because you can not afford them. The other thought is to give them a stand-by appt. They may have to wait a while to be seen.” (North Carolina dentist)

“After a new patient reschedules/misses an appointment twice, we fire/do not reschedule. When existing patients break numerous appointments we notify them to call us on a day when they have extra /free time on their schedule and we will see if we can work them in at that time (this way we are not blocking an actual appointment for them). The best approach would be to require a credit card at time of scheduling to hold the appointment.” (General dentist)

How do you handle missed appointments? Have you ever “fired” a patient?

Dentist Missed Appointments Fees Average $50

Missed dental appointments: average fee is $50Miss a dentist appointment and it could cost you $50. That’s the average missed dentist appointment fee reported by dentists in this survey.

However, 30% don’t charge a fee for missed dental appointments or late cancellations. In fact, only 10% charge a fee the first time; 41% wait until the second time, and 18% wait until the third offense.

By the third dentist appointment no-show, nearly half (43%) of dentists are ready to stop seeing that patient entirely.

Here are some more comments on missed appointment policies:

  • “We collect $$$ up front when they make appointment (eg. all my sedation dentistry cases) or no appointment is made.” (Florida dentist)
  • “Patients always miss appointments… After the first failure, we make them prepay ahead of time for their next treatment appt.” (Tennessee dentist)
  • “Broken appointment fees are one way, but reserving the appointment with a Visa/Mastercard may be more positive.” (Kentucky dentist)
  • “Patients sign a form stating they will be charged if they miss an appointment.” (New York dentist)
  • “Try to get them to pay when they make and appointment. They will then rarely miss.” (General dentist)
  • “Miss one and they get rescheduled out 6 weeks. Miss 2 and they get a fee. Miss 3 and they go on our short notice appt list.” (Pediatric dentist)
  • “SMS text message to confirm, day, date and time.” (General dentist)
  • “They need to find a dentist with a more convenient dentist office.” (General dentist)
  • “Usually if they pay the fee, they come on time, or they get mad and leave.” (Wisconsin dentist)
  • “We have them secure their appointment with a non-refundable fee if they want to return to our practice.” (General dentist)

Read more: Missed Dental Appointment Fees: Dentist Policies

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