The short answer
Insurance and government programs generally don't pay for missed sessions, so a no-show is lost income for a therapist paid per session. Practices handle it with cancellation policies and fees, where program rules allow them. Who carries the loss depends on your setting: you in solo practice, and whatever your contract says elsewhere.
Why do no-shows cost therapists money?
Because payers pay for services delivered, not time reserved. TRICARE, for example, says plainly that it doesn't cover charges for missed appointments, and CHAMPVA pays for care provided, not missed sessions. For a therapist paid per session, the hour is simply gone, and often too late to fill.
Who carries the risk in different settings?
| Setting | Who absorbs a no-show |
|---|---|
| Solo private practice | You, unless your fee policy recovers some of it |
| Salaried W-2 job | The employer, though no-shows may count against productivity |
| Per-session W-2 or 1099 | Usually you |
| Network or platform | Whatever the contract says; ask |
How do no-show and cancellation policies work?
A typical policy sets a cancellation window, often 24 or 48 hours, and a fee for late cancellations or no-shows. To be fair and enforceable:
- Put it in writing and get the client's signature at intake.
- Apply it consistently.
- Allow reasonable exceptions for emergencies.
- Set the fee so it encourages respect for the time without punishing clients.
What limits apply?
Program rules can limit or bar no-show fees. VA's Community Care Network provider manuals, for example, say participating providers may not charge Veterans for missed authorized appointments. Check each program's rules before billing a client for a missed session.
What helps reduce no-shows?
- Reminders by text or email.
- Easy rescheduling, including self-scheduling.
- Telehealth, which removes travel barriers.
- Talking about missed sessions clinically. A pattern often means something.
How ValorWell handles this
When a client no-shows, ValorWell bills the client a reduced no-show fee where program rules allow it, and the full amount goes to you. ValorWell keeps none of it. The fee is set to encourage clients to respect your time, not to punish them.
VA Community Care doesn't allow no-show charges, so those clients can't be billed for a missed session. To protect therapists' time, ValorWell limits how many sessions a Community Care client can miss.
Important limits
- Program rules come first. Where a payer's rules don't allow charging the client, those rules apply.
- No-show fees don't replace a full session. The fee is reduced on purpose.
- Missed sessions still need attention clinically, especially for clients at risk.