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I’ve been billed for missing a campus psychiatrist session. Must I pay?

The question: I am a university student who received an invoice for $90.36 for missing my appointment with a psychiatrist at student health services. I had mentioned I would be away but I was still billed. I am wondering if I have to pay this fee and if there is a place I can go for help if the doctor insists on payment. Also, can the university freeze my student account and not provide transcripts if I don't pay the fee?

The answer: Psychiatrists do bill for missed appointments because if you don't show up, they don't get paid. In your case, however, it sounds as if there was a miscommunication. Whether you pay that outstanding fee or not, do not be concerned about the university freezing your accounts, transcripts and tuition.

"It does not impact at all on his relationship," Patricia Mirwaldt, director of student health services at University of British Columbia, pointed out in a telephone interview from Vancouver. "We won't have a hold on a student's account or anything like that."

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With that out of the way, you still have the issue of the outstanding fee. Virtually all psychiatrists bill for missed appointments partly out of pragmatism because they need to be paid for their time. But they also want be make sure the patient is committed to therapy. Some patients have a tendency to miss sessions when the hard slogging of therapy becomes painful.

Psychiatrists typically insist on advance notice when cancelling an appointment – the more time you can give the better. At UBC, because students are learning to become responsible users of medical services, they are forgiven for one mistake. That means if you are a no-show, you get a break. But after that, the rules are enforced.

"Remember, this means you would have to pay for it the next time it happens," said Dr. Mirwaldt. "We record it in their chart that yes they were reminded of the policy."

Generally, psychiatrists do understand money is an issue for students. In some cases, students pay as little as $10 a month toward their missed appointment fees, according to Dr. Mirwaldt.

Your point is that you did not miss your session but provided one week's verbal notice. Despite that, you still received a bill. I suggest you raise this issue with student health services to learn of their policy on missed appointments, and then raise it with your psychiatrist during the next session.

It can be difficult to bring up these issues with a therapist, especially because of the power imbalance. But if you don't discuss it, the issue will hang in the air like stale cigarette smoke.

Start by saying you want to discuss something you find difficult to get the conversation rolling. Mention that you thought you had provided proper notification. Before you leave, make sure you have a clear understanding of the psychiatrist's rules for cancelling future appointments.

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