More and more I am seeing new names on my client roster. Looking back on how many actually show up for their appointment can be mind boggling. Performing diagnostic assessments (DA) is an all or nothing proposition. Out of the 4-5 DA’s that may be scheduled daily, on average 2-3 may show up. The clients that do not show usually do not call to cancel. The clients that cancel usually cancel 3-4 times before they show up for their DA, which is the initial face-to-face contact with our agency.
Our agency established a $35 fee for clients who miss an appointment or who do not give 24hr notice for cancellation. This simple action has improved our show rate for established clients’ agency wide because it starts to hold the client/family accountable. Most of our clientele is covered under public insurance and this covers all expenses that someone who may have private insurance with a deductable or someone on sliding scale would have to pay out of pocket. Most of the clientele who miss an appointment or cancel at the last minute are covered by their public insurance.
The public insurance is great for those who are unemployed, under insured, not insured, or who have specific medical needs. I believe we need to continue with the public option for families who do not have the financial resources to afford high premiums or for those whose employment does not provide insurance. Looking at all the benefits and opportunity that public insurance gives to families for specific needs they would not be able to get elsewhere; there is a specific disadvantage for those who have public insurance and for those who are a reimbursed provider of public insurance.
The major disadvantage I see is no accountability for those who have public insurance. There is no co-pay, no premium, no financial obligation whatsoever since the public insurance is funded by public tax dollars. Clients and families who miss scheduled sessions or who cancel at the last minute are not financially harmed because there is no accountability for inconsistency or lack of follow through. Public insurance is not set up to be billed for a client missing a session or not giving enough notice to fill the cancelled time. This fosters dependence and a sense of apathy and even entitlement. The dependence is hurting the client/family and the lack of reimbursement is hurting the agency that just lost out on an hour of billing.
As I mentioned above, the agency I work at established a $35 fee which drastically reduced our clients from missing a session w/o calling or not giving 24 hrs notice for cancellation. Those who were charged the fee paid it and if they did not pay the fee they no longer receive services until the fee is paid. Accountability is the keystone to advancing beyond what we thought we were capable of doing. Without someone/place/thing holding us accountable, dependence and eventually apathy develops and concern for others becomes nonexistent.
I was always told that if someone would open up his/her checkbook you would be able to find out what the passion of his/her heart is and what is most important in his/her life. I firmly believe that accountability will breed self-sufficiency through self-awareness.
We must hold our clients accountable for their actions or inaction. It is hard, uncomfortable, and even scary at times but it is necessary! Clinicians, BE STRONG! STAND FIRM! Only good can come from accountability. Will we lose clients? Yes, but that is ok. The client/family must be ready to be held accountable in order to continue. If they never come back for services, know that you planted a seed of accountability and hopefully someone else will water that seed for continued growth.
Josh Andrews is a counselor at a behavioral health agency working with children, adolescents, and families. His professional interests include the spiritual side of humankind, cognitive behavior therapy, reality therapy, and advancing the knowledge and practice of professional counseling.