Missed appointments happen. To ensure consistent client care and accurate billing, therapists must follow a standard process for outreach, documentation, and marking sessions in the portal. This article outlines Rula’s policy, the steps you should take, and how exceptions are managed.
Defining Late Cancellations and No-Shows
-
Late cancellation
- Client cancels a scheduled session with less than 24 hours' notice,
- OR the client arrives more than 15 minutes late to the scheduled appointment
-
No-show
- The client does not show up for the appointment.
- AND the client does not attempt to contact their therapist or Rula Support in advance
In both cases, therapists are required to complete a Missed Appointment Note and document outreach for that session in order to be paid for their time. A Missed Appointment Note is not required for appointments canceled more than 24 hours ahead of time.
Required Client Outreach Timeline
If a client does not join at the scheduled start time, therapists are required to follow these steps:
3 minutes after start → Resend the session link to the client via email (see how here).
5 minutes after start → Call the client
15 minutes after start → Mark the appointment as a no-show if the client has not joined
Tip: For intake appointments, cancel any auto-scheduled recurring sessions and reach out to the client to reschedule.
Documentation Requirements
All no-shows and late cancellations must be documented in the portal:
-
Complete a Missed Appointment Note
- Select the appropriate reason
- Record your outreach attempts
- Indicate whether the client should be charged
See Completing a Missed Appointment Note in the Provider Portal for step-by-step instructions with screenshots.
Exception Cases
Our internal policy outlines a few situations when a fee may be waived. This information is not shared with clients, but is something for you to know as the treating provider.
| Situation | Will the clinician be paid? | Will the client be charged? |
| Rula fails to cancel an appointment upon request before 24 hours | YES | NO |
| Technology is not functional, and the clinician did not attempt to reach out to the client via other methods | NO | NO |
| Clinical discretion | NO | NO |
| Client rescheduled on the same day | NO | NO |
| Unexpected emergency | NO | NO |
We've agreed as an organization that an unexpected emergency will be clearly defined and adhered to by all team members. This information will NOT be shared with clients, but Rula will decide if this applies during a dispute. The circumstances include:
- A natural disaster prevented the client from attending the appointment.
- A medical emergency that required the client or their immediate family member to be under the care of a healthcare professional(i.e., nurse, physician, paramedic);
- An unplanned legal emergency that interfered with the client's ability to attend the appointment (i.e., law enforcement or protective services involvement);
- A situation involving intimate partner violence in which the client was unable to attend the appointment safely.
Example Scenarios
Now that we've reviewed the policy, let's look at some examples of situations therapists may encounter and whether or not the patient should be charged.
| Scenario | Can the patient be charged? |
| The client had a scheduled appointment at 11 am. The client showed up at 11:03 am and he was currently driving and was on his way to another appointment. The therapist could not hold the session as the client was driving and suggested a reschedule. The client agreed and scheduled for next week. | Yes. The appointment was rescheduled to the next week, not later within the same day. If the client was able to reschedule the appointment for later that same day, they would not be charged. |
| The client was logged on to Zoom, but their video and sound were not working. The therapist sent a message in the Zoom chat asking if they were there, but they did not answer. The therapist did not offer an alternative platform or telephone call for the session. The appointment did not happen. | No. In this instance, the therapist needed to offer an alternate route for holding the session since the patient was unable to get Zoom to work. |
| The client had an appointment at 2:00 pm. On the therapist's initial outreach at 2:03, the patient responded and said he forgot but would be on in 5 minutes. At 2:10, the therapist reached out again with no response. At 2:20, the therapist has yet to hear from the patient. | Yes. After following the outreach guidance in the no-show and late cancellation policy, this example merits a no-show/late cancellation fee. |
| The client canceled their appointment a few hours before it was scheduled. The therapist is aware of the situation that caused the client to cancel and believes that a no-show fee in this situation may cause undue stress. However, the cancellation happened within 24 hours of the appointment. | Use Clinical Discretion. Even if the patient meets the criteria for a no-show/late cancellation, therapists can use clinical discretion and decide to waive the fee should they choose to. However, they are also agreeing to not be paid for the session by doing so. |
Managing disputes
Rula’s Support team handles all no-show and late cancellation disputes. If a client has questions about fees, please direct the client to use the AI search bar in the Patient Help Center to get assistance. They can request a live Service Team member at any time.
Once you’ve completed and submitted a Missed Appointment Note, you'll not be involved in the fee decision process. This allows you to stay focused on your clinical work and client relationship, while Rula takes care of billing details.
If a dispute arises and no Missed Appointment Note was entered, our team may contact you for clarification. The Billing team will also notify you if a no-show charge you submitted is later waived under policy.
Clients agree to Rula’s cancellation and no-show policy at the time of registration, so they are aware of these expectations from the start.
Script for therapists to use when patients reach out about a fee dispute:
- "I understand your concern about the missed appointment fee. Rula’s Support team handles all questions about billing and fees directly. You can reach them by using the AI search bar in the Patient Help Center to get assistance. You can request a live Service Team member at any time and they’ll be happy to review your situation. My role is to support you clinically, while Rula’s team takes care of the billing side.
Quick Reference of No-Show Expectations
Attempt to outreach the client(3/5/15-minute rule)
Complete a Missed Appointment Note
Mark the session in the provider portal
Do not handle disputes directly with clients (handled by Support)
Do not promise fee waivers (handled by Support)
Related articles
Managing Cancellations, Deletions, and Missed Appointments in the Rula Provider Portal
- Appointment No-Shows and Late Cancellations Policy
Updated