No-show requirements

This article reviews no-show requirements at Rula and best practices on late client outreach, documentation, and managing disputes. Please see this article for Rula's official no-show and late cancellation policy. 

Late client outreach:

Clinicians will be required to take the following steps when a client is not present at the start of a scheduled appointment: 

  • At 3 minutes: Resend the link to the client via email (see this article)
  • At 5 minutes: Call the client
  • After 15 minutes: Consider the client a no-show

Note: If the no-show is for an intake appointment, make sure to cancel the recurring appointments that are automatically set up. Reach out to the client to reschedule their intake appointment.

Documenting outreach attempts:

Once you've determined that the client is a no-show, you'll first complete a missed appointment note. This step is required whether or not the patient will be charged. If you are waiving the no-show charge, you do not need to fill out a charge slip. If the patient will be charged, you'll need to fill out a charge slip after completing the missed appointment note. 

Missed appointment note.png
Mark the client as a no-show from the scheduler. 

  • Charge means the client will be charged, and you will be paid
  • No charge means the client will not be charged, and you will not be paid 

charge or no charge.png

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 outreach 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

The critical final point is that Rula's Support team manages disputes. Please direct the client to contact Support at or 323-205-7088. Clinicians will not be involved in decision-making around no-show fees once you have entered your Missed Appointment note in the chart. We'll take care of those details to ensure you can focus on the relationship with the client. Note that if you do not complete a Missed Appointment note for a no-show, we will still need to reach out to you if there is a patient dispute. Our Billing team will let you know when an appointment that you charged as a no-show is waived under the new policy. 


What about the no-show policy that patients sign?

We will continue to have clients agree to our cancellation and no-show policy when they register for services. The patient-facing no-show policy is not changing. Please review this with each client in the first session. Every appointment reminder also mentions the no-show policy.

This new policy goes into effect today. All of our Support agents have been trained and understand the latest protocols to be sure we are all aligned and following our policy consistently. Thank you for voicing your concerns, sharing your feedback on the definition of an unexpected emergency, and continuing to support your clients on their therapeutic journey!

Was this article helpful?

0 out of 0 found this helpful