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 preserved, the fee must be agreed upon transparently beforehand, 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 specificities 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 any alternative.

At the same time, the topic is psychologically sensitive: patients who miss an appointment sometimes do so precisely when they are feeling very unwell – a symptom, not indifference. A rigid no-show fee in this context can strain the therapeutic relationship. This does not mean that you have to waive a fee – but it means that communication and goodwill arrangements 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 laborious: 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 flat fee agreed in advance 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 GTCs or an explicit agreement in the intake form – a practice that is already standard in psychotherapy anyway (consent form, privacy policy, fee agreement).

3. The ethical dimension: When goodwill is appropriate

The Swiss Patients' Organisation (SPO) and various professional associations recommend goodwill for cancellations through no fault of one's own. In psychotherapy, this applies in particular: if someone misses an appointment because they are very unwell, an automatic fee is counterproductive. The fee should be an incentive for adherence to appointments – 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 event of a proven emergency. Note this goodwill rule internally and apply it in case of doubt. This strengthens the therapeutic relationship and makes your 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 for short-notice cancellations without filling the slot is proportionate – the slot cannot be filled spontaneously. In the event of a longer warning (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 safeguard 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 reserved. If the client appears for the appointment, billing is carried out normally (or the payment link is sent after the session). In the event of a no-show, the pre-authorized fee is debited with just 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 that clients who wish to pay exclusively with TWINT cannot deposit a credit card guarantee. As an alternative: TWINT prepayments for the session with a promise of refund in the event of cancellation in due time.

Important note on the setting

The credit card guarantee must be carefully introduced in the therapeutic context. Recommendation: explain the safeguard in the intake form or initial consultation – not as an expression of distrust, but as a structural practice regulation that applies to everyone. This reduces resistance and makes application in individual cases less problematic.

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

Credit card data must not be stored in the electronic medical record – the PCI-DSS certified PSP takes care of this. Payrexx stores payment data tokenized, no plain text numbers. For your practice: payment data remains in the Payrexx Dashboard, patient data in the practice software. No linking, no shared database.

According to the revised DPA (since September 2023), Payrexx is a data processor. Conclude a data processing agreement (DPA) according to DPA Art. 9 with Payrexx. In psychotherapy, special requirements also apply to sensitive personal data (health data according to DPA 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 the psychotherapy practice: Sample wording

The following wording is recommended for GTCs or the intake form:

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

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

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

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

• Integrate the policy into the intake form and request written consent

• Set up pre-authorization in the Payrexx Dashboard (Visa, Mastercard, Mobile Wallets)

• For TWINT clients: prepayment with a promise of refund as an alternative

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

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

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

• Conclude a data processing agreement (DPA) with Payrexx (DPA Art. 9)

Payrexx supports pre-authorization for Visa, Mastercard and Mobile Wallets in all plans including Free. The credit card is deposited during booking, 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 prepayment as an alternative with a refund option within 30 days.