Fees for non-attendance in dental practices: Procedure for patients who do not show up
What can you do in your practice if patients don't show up for an appointment? We explain the possibility of cancellation fees and what you need to consider legally.
If a patient does not show up for treatment at the dental practice despite having made an appointment, this is not only a nuisance in terms of the preparation and scheduling of the staff - it can ultimately also mean a financial loss for the practice if the appointment could not be made elsewhere. In this article, we therefore want to examine the question of whether the practice can claim compensation from the patient in this case.
What is the legal situation if a patient does not show up?
What happens if a patient does not appear at the agreed appointment is not clearly regulated by law. However, many courts have already dealt with this question, so that at least a clear tendency in their assessment can be recognized. As a rule, an entitlement to a cancellation fee has been affirmed, in some cases under further conditions.
The claim was predominantly based on Section 615 of the German Civil Code (BGB), also most recently by decision of the Federal Court of Justice. According to this, a claim for reimbursement exists because the doctor has offered the patient the contractually owed service in the form of the treatment appointment, but the patient has not accepted this as contractually owed due to his non-appearance, so-called "default of acceptance".
Based on this, case law generally set the following requirements for the affirmation of the default fee:
- The practice was unable to use the canceled appointment elsewhere at short notice.
- The patient must have been aware that there is a risk of a cancellation fee in the event of a no-show.
What happens if the appointment can be reassigned?
If the practice was able to make profitable use of the appointment elsewhere, in particular by treating another patient, it is not entitled to a cancellation fee. However, this will generally not be possible in most practices due to the long lead times for appointments.
Does the patient need to know about the impending default fee?
In some cases, it has been argued that the patient was at least aware of the impending cancellation fee - in particular because this was clearly pointed out when the appointment was made. In other cases, it was even argued that the patient should have clearly agreed to this. In these cases, it is again unclear how such consent should be given. In any case, the requirement for handwritten consent would be out of step with the everyday practice of making appointments by telephone or digitally.
How high can the default fee be?
Unfortunately, there is also no unambiguous clarity regarding the amount of the default fee.
In some cases, courts have applied seemingly arbitrary lump sums, and in others, average treatment costs have been used as a basis. In other cases, the fees for the planned treatment were applied. However, the practice will have to take into account costs saved, for example in the form of unused material.
Conclusion: How should practices deal with the default fee?
Even if the legal provisions governing the fee for lost time are not clear, the case law of recent years shows a clear trend towards the recognition of a claim for a lost time fee by the patient
Nevertheless, it must also be noted that the case law is not uniform, in particular with regard to the question of the extent to which the patient was informed about the impending default fee or should even have expressly agreed to this - and if so, in what way.
Various rulings also contain further requirements or comments, for example, a cancellation fee should not apply if an alternative appointment has been agreed with the patient, which is at least surprising in view of the damage caused by the missed appointment.
Recommendation: What should practices do when patients don't show up?
Unfortunately, it is not possible to give a clear recommendation against the background of the still unclear legal situation, as it cannot be ruled out that individual courts will judge the specific case differently or set different requirements.
If the practice wishes to keep the option of claiming a cancellation fee open, it should act with as much legal certainty as possible, particularly in the area of informing the patient and obtaining their consent to the cancellation fee. As handwritten consent is difficult to implement in day-to-day practice, at least a note with the option of consent by the patient should be clearly integrated - for example in the digital registration process.
Please note that this guide has been prepared for information purposes only, has no legally binding effect and does not constitute legal advice. The final responsibility remains with the practices and doctors themselves.
About the author: Tobias Kirchgessner, General Legal Counsel, worked as a lawyer for nine years, including in medical law, before joining Nelly. He has been supporting Nelly Solutions GmBH in all legal matters since January 1, 2024.
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Electronic signatures in healthcare: Guidance for dentists
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If a patient does not show up for treatment at the dental practice despite having made an appointment, this is not only a nuisance in terms of the preparation and scheduling of the staff - it can ultimately also mean a financial loss for the practice if the appointment could not be made elsewhere. In this article, we therefore want to examine the question of whether the practice can claim compensation from the patient in this case.
What is the legal situation if a patient does not show up?
What happens if a patient does not appear at the agreed appointment is not clearly regulated by law. However, many courts have already dealt with this question, so that at least a clear tendency in their assessment can be recognized. As a rule, an entitlement to a cancellation fee has been affirmed, in some cases under further conditions.
The claim was predominantly based on Section 615 of the German Civil Code (BGB), also most recently by decision of the Federal Court of Justice. According to this, a claim for reimbursement exists because the doctor has offered the patient the contractually owed service in the form of the treatment appointment, but the patient has not accepted this as contractually owed due to his non-appearance, so-called "default of acceptance".
Based on this, case law generally set the following requirements for the affirmation of the default fee:
- The practice was unable to use the canceled appointment elsewhere at short notice.
- The patient must have been aware that there is a risk of a cancellation fee in the event of a no-show.
What happens if the appointment can be reassigned?
If the practice was able to make profitable use of the appointment elsewhere, in particular by treating another patient, it is not entitled to a cancellation fee. However, this will generally not be possible in most practices due to the long lead times for appointments.
Does the patient need to know about the impending default fee?
In some cases, it has been argued that the patient was at least aware of the impending cancellation fee - in particular because this was clearly pointed out when the appointment was made. In other cases, it was even argued that the patient should have clearly agreed to this. In these cases, it is again unclear how such consent should be given. In any case, the requirement for handwritten consent would be out of step with the everyday practice of making appointments by telephone or digitally.
How high can the default fee be?
Unfortunately, there is also no unambiguous clarity regarding the amount of the default fee.
In some cases, courts have applied seemingly arbitrary lump sums, and in others, average treatment costs have been used as a basis. In other cases, the fees for the planned treatment were applied. However, the practice will have to take into account costs saved, for example in the form of unused material.
Conclusion: How should practices deal with the default fee?
Even if the legal provisions governing the fee for lost time are not clear, the case law of recent years shows a clear trend towards the recognition of a claim for a lost time fee by the patient
Nevertheless, it must also be noted that the case law is not uniform, in particular with regard to the question of the extent to which the patient was informed about the impending default fee or should even have expressly agreed to this - and if so, in what way.
Various rulings also contain further requirements or comments, for example, a cancellation fee should not apply if an alternative appointment has been agreed with the patient, which is at least surprising in view of the damage caused by the missed appointment.
Recommendation: What should practices do when patients don't show up?
Unfortunately, it is not possible to give a clear recommendation against the background of the still unclear legal situation, as it cannot be ruled out that individual courts will judge the specific case differently or set different requirements.
If the practice wishes to keep the option of claiming a cancellation fee open, it should act with as much legal certainty as possible, particularly in the area of informing the patient and obtaining their consent to the cancellation fee. As handwritten consent is difficult to implement in day-to-day practice, at least a note with the option of consent by the patient should be clearly integrated - for example in the digital registration process.
Please note that this guide has been prepared for information purposes only, has no legally binding effect and does not constitute legal advice. The final responsibility remains with the practices and doctors themselves.
About the author: Tobias Kirchgessner, General Legal Counsel, worked as a lawyer for nine years, including in medical law, before joining Nelly. He has been supporting Nelly Solutions GmBH in all legal matters since January 1, 2024.
Possibly also interesting:
Electronic signatures in healthcare: Guidance for dentists
Digital patient information - permissibility and framework
Tobias Kirchgessner
General Legal Counsel @Nelly Solutions
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