Yes, a doctor can charge a Medicare patient for a missed appointment, as long as the office charges all patients the same policy and the same amount. That's CMS's stated policy in the Medicare Claims Processing Manual. Medicare doesn't pay these fees, so the charge is yours, but you can ask to see the policy and ask for it to be waived.
What does Medicare's rule say?
The Medicare Claims Processing Manual (Chapter 1, section 30.3.13) says CMS allows physicians and suppliers to charge Medicare beneficiaries for missed appointments, as long as:
- They don't single out Medicare patients. The policy has to apply to non-Medicare patients too.
- The amount is the same for Medicare and non-Medicare patients.
The manual explains that a missed appointment charge isn't a charge for a service. It's a charge for a missed business opportunity. So the usual Medicare limits on what doctors can bill for services, like assignment and the limiting charge, don't apply to it.
Will Medicare or my Medigap plan pay it?
No. The manual says Medicare doesn't make any payments for missed appointment fees, and they shouldn't be billed to Medicare. Medigap pays its share of Medicare-covered services, so it won't cover a no-show fee either.
If a missed appointment charge was sent to Medicare, the claim should be denied. You might see that on your Medicare Summary Notice. See how to read your Medicare Summary Notice.
Are there exceptions for hospitals?
One. The manual says a hospital outpatient department can usually charge a missed appointment fee. But if you were a hospital inpatient and missed an appointment in the hospital's outpatient department, charging you for it would violate Medicare rules for hospitals.
So if your parent was admitted and missed an outpatient test or clinic visit during that stay, ask the hospital to remove the fee.
What should I check before paying?
- Was there a posted or written policy? Some offices ask you to sign one at check-in. Ask for a copy.
- Does the policy apply to everyone? Ask whether the same fee applies to patients without Medicare.
- Is the amount the same as in the policy?
- Did you actually miss it? Check your calendar, reminder texts, or call logs. Maybe you canceled in time or the office rescheduled.
- Were you an inpatient at the time? If so, see above.
How do I ask the office to waive it?
Offices set their own policies, so a waiver is up to them. It doesn't hurt to ask, especially for a first time or a good reason, like a hospital stay or a family emergency.
What to say:
"I got a $[amount] missed appointment charge for [date]. I missed it because [reason]. This is the first time. Would you be willing to waive it this once? I've rescheduled for [date]."
If you think you canceled in time:
"I called on [date] to cancel my appointment for [date]. Could you check your records? I'd like this charge removed."
If you want to check the policy:
"Can you send me a copy of your missed appointment policy? I'd also like to confirm the fee is the same for patients who don't have Medicare."