No-show fees in psychotherapy: Legal situation, ethics and implementation in Switzerland

Psychotherapists in Switzerland are allowed to charge no-show fees – but the ethical dimension is more complex than in other practices. The relationship of trust must be maintained, the fee must be transparently agreed upon in advance, and the technical implementation via credit card guarantee only works with Visa or Mastercard – TWINT does not support pre-authorization.

This guide explains the Swiss legal situation (CO Art. 160 et seq.), shows the ethical peculiarities in the psychotherapeutic context and describes the technically correct implementation.

1. Why no-shows are particularly problematic in psychotherapy

An unexcused missed appointment in psychotherapy is structurally different from one in physiotherapy: the 50-minute slot can hardly be filled at short notice. Psychotherapeutic sessions cannot be booked spontaneously – they are planned long-term and embedded in a therapeutic process. For the therapist, a free slot almost always means a loss of income without an alternative.

At the same time, the topic is psychologically delicate: patients who miss an appointment sometimes do so precisely when they are feeling unwell – a symptom, not indifference. A rigid no-show fee in this context can strain the therapeutic relationship. This does not mean that a fee has to be waived – but it means that communication and goodwill regulations must be designed with particular care.

2. Legal situation: CO Art. 160 et seq. and the contractual penalty

As in other therapy practices, booking an appointment creates a contract – also in psychotherapy. If one party does not comply with the contract, the other can claim damages (CO Art. 97 et seq.). In practice, this is time-consuming: the therapist must prove that the slot could not be filled otherwise and that actual damage has occurred.

The more elegant solution is the contractual penalty according to CO Art. 160 et seq.: a pre-agreed flat rate that is due without proof of damage. Prerequisite: The regulation must have been communicated and accepted when the appointment was made. This is done via GTC or an explicit agreement in the admission form – a practice that is common in psychotherapy anyway (consent form, privacy policy, fee agreement).

3. The ethical dimension: When goodwill is appropriate

The Swiss Patient Organization (SPO) and various professional associations recommend goodwill in the event of cancellations through no fault of the patient's own. This is particularly true in psychotherapy: if someone misses an appointment because they are feeling very unwell, an automatic fee is counterproductive. The fee should be an incentive for adherence – not a punishment in a crisis situation.

Recommended practice: First no-show always without a fee, combined with a conversation about the importance of regular sessions. From the second no-show with a fee, but with an exception in the case of a proven emergency. Note this goodwill rule internally and apply it in case of doubt. This strengthens the therapeutic relationship and makes the practice perceived as fairer.

4. How high can the no-show fee be?

In psychotherapy, a fee of 50% to 100% of the session price is proportionate in the event of short-notice cancellation without replacement – the slot cannot be filled spontaneously. In the case of longer notice (more than 48 hours), either no fee or a reduced flat fee is recommended.

5. Technical implementation: Credit card guarantee via Pre-Authorization

The most effective technical protection is pre-authorization when making the appointment: the client provides credit card details, but no amount is debited immediately. The card is checked and an amount is reserved. If the client appears for the appointment, billing proceeds normally (or the payment link is sent after the session). In the event of a no-show, the pre-authorized fee is debited with a few clicks in the Dashboard.

Payrexx supports pre-authorization for Visa, Mastercard (debit and credit), Apple Pay, Google Pay, and Samsung Pay. TWINT does not support pre-authorization. This means: clients who wish to pay exclusively with TWINT cannot deposit a credit card guarantee. As an alternative: TWINT pre-payment of the session with a promise of refund in the event of timely cancellation.

Important note on the setting

The credit card guarantee must be carefully introduced in the therapeutic context. Recommendation: Explain the protection in the admission form or during the initial consultation – not as a vote of no confidence, but as a structural practice rule that applies to everyone. This reduces resistance and makes application in individual cases less problematic.

6. DSG-compliant implementation: Separate credit card data and patient data

Credit card data must not be stored in the electronic health record – this is handled by the PCI-DSS certified PSP. Payrexx stores payment data tokenized, not in plain text numbers. For the practice: payment data remains in the Payrexx Dashboard, patient data in the practice software. No link, no shared database.

According to the revised FADP (since September 2023), Payrexx is a data processor. Conclude a data processing agreement (DPA) according to FADP Art. 9 with Payrexx. In psychotherapy, special requirements also apply to sensitive personal data (health data according to FADP Art. 5 lit. c): the payment solution must not contain any diagnoses or psychological findings – neither in the booking text nor in transaction descriptions.

7. No-show policy in psychotherapy practices: Sample wording

For the GTC or admission form, this wording is recommended:

'In the event of appointment cancellations less than 24 hours prior to the agreed session or in the event of unexcused absence, a cancellation fee of EUR [amount] will be charged. The fee will be waived in the event of a proven emergency. The first missed session remains free of charge. The fee will be debited via the credit card deposited at the time of booking or sent by invoice.'

This formulation covers the essential elements: deadline, amount, exception, goodwill rule (first session free of charge), payment method.

8. Checklist: Setting up a no-show policy in psychotherapy practices

• Formulate a clear no-show policy: cancellation deadline, fee amount, first-session-free rule, emergency exception

• Integrate the policy into the admission form and require written consent

• Set up pre-authorization in the Payrexx Dashboard (Visa, Mastercard, mobile wallets)

• For TWINT clients: pre-payment with refund promise as an alternative

• Explain the credit card guarantee in the initial consultation as a structural practice rule for everyone

• Note goodwill regulations internally: when will the fee be waived

• Strictly separate payment data and patient data: no diagnoses in the booking text

• Conclude a DPA with Payrexx (FADP Art. 9)

Payrexx supports pre-authorization for Visa, Mastercard and Mobile Wallets in all plans including Free. The credit card is deposited at the time of booking, and in the event of a no-show, you debit the fee with just a few clicks in the Dashboard. For clients without a credit card: TWINT pre-payment as an alternative with a refund option within 30 days.