Man livid with couples counselor when she charges $165 cancellation fee; 'Really? My fiancé had a dangerous miscarriage.' AITA? BIG UPDATE
When this man is furious with his couples counselor, he asks the internet:
"My Therapist wants to charge my fiance and I cancellation charge for missing appointment. She was having a miscarriage. AITA?"
Shortly after moving in together, my fiance and I started to have some major relationship issues revolving around trust and perspectives on finance. We both decided to pursue couples counseling.
We first met with our therapist 10 weeks ago. At first, I felt like she failed to hold my fiance accountable fo her actions. That said, I decided to keep an open mind and give it a few sessions.
2-3 weeks after starting therapy we realized fiance was pregnant (we were pseudo-trying, then realized that was a naive approach given our issues). Nevertheless, I supported my fiances decision to carry our child to term.
Therapy has been going quite well and our relationship is stronger than ever. Our last therapy session happened last Tuesday, shortly before our second ultrasound.
The ultrasound showed no signs of gestation past 6 weeks and no heartbeat. Our OB-GYN prescriped Misoprostal, RX grade Ibuprofen, and Norcan. Fiance started meds that night and finished by afternoon. She bled a lot, but didn't produce a significant amount of embryonic tissue.
Fiance did well over weekend and appeared to be on the mend last night. We both planned on coming to our appointment (in person) at 9am today.
However, fiance woke up this morning with a sharp abdominal pain. She took her high dose of Norcan and Ibuprofen at 7:30am. By 8am, she felt better but still tired and ouchy. I e-mailed therapist letting her know the situation.
Fiance, therapist and I previously discussed Zoom calls if fiance was feeling less than stellar due to baby stuff. However, I did not feel that fiance would be cogent or well enough for even a zoom call.
I e-mailed therapist to inform her of the miscarriage, that fiance was not doing well, and as such we would not be able to make our appointment this morning. Therapist replied with a courteous email.
At 9:15-9:30am, the abdominal pain became MUCH worse (fiance compared it to her previous bout of appendicitis) and I was 2 minutes prior to taking her to the ER when she passed a lemon sized blood clot and a large amount of blood. She felt much better afterward and went back to sleep before I left for work.
This afternoon, I received an e-mail with a receipt for $165 for a cancellation charge. I reached out to the therapist describing what happened and asked if she could make an exception as it was a medical pseudo-emergency.
Therapist responded that its "policy to charge and its in the forms you signed at intake. When a slot is blocked for a client then no one else can have that time slot. If I do not receive 24 hour notice then it's too late for me as a clinician to add someone in that time slot which means I lose that hour as a clinician. Thank you for understanding. Again I apologize."
Personally, I'm a little miffed but I'm trying to see the forest for the trees. My fiance, my contrast, is pissed. I'm concerned the therapists refusal to practice empathy in the form of not charging us a cancellation fee because my fiance was passing the dead remnants of our would-be child throws away the trust we've built up over the last 10 weeks.
Are we justified in these feelings or are they totally off base? I understand the technicalities of the situation but feel an exception should be made given the circumstances.
I'd like to point out that of the four major replies I've received so far, not one has offered compassion and/or condolences for our loss. I find that telling.
Before we give you OP's major update let's take a look at some of the top comments/OP responses:
rraat writes:
This is a horrible situation and I am really sorry that you've both been through such a traumatic and upsetting experience. Horrible timing with the therapy session as well.
Unfortunately though, that's what it was. Horrible timing. Not your fault. Not your therapist's fault. Not your OBGYN's fault. Just a horrible set of events.
Other people have noted that this is your therapist's income which they lose if you cancel last minute AND that they likely have a waiting list who want that time slot.
I think most people would argue that this is a time when an exception could be made... but the problem is, when you start offering exceptions, where do you draw the line and how do you ensure fairness and equity?
A fallible human would have to make those decisions based on their own judgment, what if you had the same situation but had cancelled frequently in the past, should they still waive the fee?
What if you had the same situation but more or less financial pressure? What if you had a less distressing medical issue but still missed the session? What if you had a bereavement? What if your boss threatened to fire you if you left the office? What if your tire blew on the drive over?
There is so many possible reasons for someone to have to cancel last minute and variables that could affect a practitioner's decision.
It becomes difficult to be fair in decisions and you run the risk that people who see different practitioners at the same clinic or who know someone else who goes there or hear a story get miffed because one person didn't get charged while they did.
The most straightforward and fair thing is to have a blanket policy with no exceptions. It is a horrible situation for you to be in but ultimately I don't think your therapist has done anything wrong and if you otherwise find them empathetic and helpful, I would really caution you against ending the relationship based on this.
Actually, it might be helpful for both of you to explore this reaction with the therapist in the context of how you both manage adversity separately and together. However, if you feel the relationship is irreparably damaged, it's reasonable to go elsewhere.
I would also say... you and your fiance need to focus on processing and grieving your loss right now, not distracting yourselves with anger at an external difficulty. Whatever helps you move on to doing that fastest is probably the best option for you."
OP Responds:
Thank you for your compassion. That said, I'd argue that it's more cut and dry than you think. My fiance and I have been attending weekly sessions with this therapist without fail.
If we had previously cancelled in the past, I would not anticipate an exception. I'm not sure what you mean by more or less financial pressure. If I had a less distressing medical issue, then I'm not sure if it would qualify as an emergency and would not expect discretion.
I would not expect it with bereavement as that's the type of grief we would process in therapy. I'm not sure where the boss part comes in - I still wouldn't expect discretion in that context. The tire issue would depend on whether I've missed other appointments (also, there's always Uber).
There are two points I'd like to make. First, this is not my first time in therapy. I saw a therapist in graduate school, during the early portion of my career, and again starting five years ago.
At some point, I did miss a session with < 24 hour notice. None were due to medical issues as severe at this one. For the most part, the first one (depending on how long I saw the therapist) was a courtesy. The second one...not so much.
Second, as stated previously, I've negotiated contractual work with cancellations clauses in place. Guess what? If my client otherwise provided consistent work, I gave him/her the benefit of the doubt and provided a courtesy exemption.
If it happened again, I'd enforce it and consider dropping the client. And these aren't $165 one-hour sessions, either. These were $85-100/hr 8-12 hour shifts. Over 7 years I've contracted with probably one hundred providers and have dropped only 3 because of their attitude towards bookings.
Both my fiance and I have attended our sessions in earnest and have never taken the therapist's time for granted. And unfortunately we had a severe medical issue come up less than two hours prior to our session. To insist on charging a cancellation fee seems callous and (as someone else pointed out) insensitive.
Neither of us want to address this 'external difficulty,' but we feel that ignoring it devalues our self-worth. It's clear the therapist has put a dollar sign on our professional relationship. We think we're worth more."
gigi writes:
"First off, I'm so sorry for your loss. This is actually pretty disgusting, and I am kind of sickened by the responses here too. A bit of fucking humanity would go a long way here.
If nothing else, an understanding that while you are miscarrying is not the time to send a bill for late cancellation.
If this really is an amount of money that is more important to the therapist than the relationship, then addressing this next time you meeting in a 'I'm so sorry to have to talk about money when you are dealing with such raw loss, but I still need to make rent this month' would be a more humane way to go.
As it is, this would be an end to the relationship with this therapist for me."
OP Responds:
"Thank you for being the FIRST person to say this in this entire thread. You and [user] are the two glimmers of hope I'll hold onto. Keep being awesome."
santafe writes:
My therapist is very explicit on charging a cancellation fee in just about every instance without proper notice. The one exception is if there's a medical emergency happening.
If you feel that it's throwing away the trust you've built, bring that up to her in your next session. If you feel like it'll be something that'll linger for you and affect the quality of your therapy long-term, you're going to want to consider switching therapists.
OP Responds:
To be fair, the cancellation policy does not address medical emergencies. While I'm not necesssarily willing to throw this relationship away, I cannot speak for my fiance. I understand that couples counseling is difficult and we were fortunate to find a good fit on the first try. As such, I am doing my best to navigate this tactfully.
I plan on reaching out to the office manager tomorrow regarding medical emergencies. I can understand the policy, there is just no way either one of us could have contributed to the session (even on Zoom) in a meaningful manner.
felinea7 writes:
In this case it is a sensitive topic, however the expectation was clearly defined and known from the start. It could be a nice gesture to waive this for once. But it's up to the Ts discretion.
Not something you can demand or you would be justified to be angry about. You can be angry (as people are angry with rain or other people's lives) but this would probably create rather than resolve issues.
OP Responds:
My fiance was pregnant with our child. Through no fault of her own, she miscarried. We weren't aware of this fact until 7 days ago (during this process, we did not miss or postpone any OB GYN appointments). My fiance followed the recommendations of her physician to the letter.
Through no fault of her own, my fiance developed acute, significant abdominal pain 90 minutes prior to our session. It temporarily abated, then recurred significantly until she expelled the remnants of our would-be child with a copious amount of blood. This happened during the time when we would be in session.
While asking for discretion (as we have not missed a session yet, in addition I sought individual therapy within the same group) our therapist adamantly denied it, citing group policy.
My fiance already feels as though the miscarriage was her fault. Being charged for missing the appointment (due to her significant abdominal pain because of the miscarriage) adds insult to injury.
Not something you..would be justified to be angry about. Next time we'll ask the OB GYN to suck the remnants out so we don't have to worry about being charged for another cancellation.
The same user felinea7 responds:
I think you are blinded by the intese emotions of such a traumatic experience. Despite a miscarriage being a scarring event that doesn't change other life commitments you have. It makes it harder to care about them but they are there.
With the same logic you shouldn't pay rent or gas for that day. Focus on working through the pain of this horrible situation and support your partner.
The T isn't responsible or liable to waive the agreement rule nor would this make things better. It's a nice thing if they did but they're are not obliged. Your fiance couldn't do the session and failed (for obvious reasons) to inform ahead of time. She is liable to pay. It's not up for negotiation unless the T wants out of good will to make an exception.
You T isn't responsible for the miscarriage nor for the the way you or your fiance chooses to feel about thia pre-agreed known rule. It feels more like you are redirecting your frustration to a more manageable situation vs the pain, anger and disappointment you feel for the miscarriage.
You can't fight the miscarriage (an outside force and a concluded event) but you can fight the T. This won't lead anywhere. Better work through the pain.
Good lead, your fiance feels responsible for the miscarriage. That's the core of the event and how she internalised the missed session or what consequences she sees there, what is her reaction to similar situations etc. These are topics that can be worked through with the T, topics that eventually will help settle and accept the pain of the miscarriage.
I do understand emotional turmoil brings the worst out in people sometimes so i hope you and your fience get over this hurdle. Stay strong.
And now, OP's first major update:
After receiving the bell curve of responses, I left a message for the clinic manager to call me back. She emailed me, stating that she was at home with a sick newborn but would be happy to discuss things over email.
I replied with a polite but detailed and vivid depiction of what had transpired. At the end, I simply asked her if it was the policy of their counseling group to charge the cancellation fee regardless of the circumstances.
About ten minutes later, she called me directly. During that time she read my email, spoke with the owner of the practice, and forwarded the email to him. She said that while she did not have the power to refund cancellation fees, he would be in touch either that night or the next morning.
I didn't hear anything by late morning Friday, so I sent a follow up email. The clinic owner called me less than five minutes later.
We spoke for about ten minutes. He was solemn, direct, and respectful. He apologized for what we were going through and explained that him and his wife had suffered miscarriages as well. He was also sorry that we should even have to deal with this following such a devastating loss.
He clarified the cancellation policy: for him, it protects the practitioners from those who repeatedly abuse the appointment system. He acknowledged that we had never missed an appointment, so prima facie we did not fall into the normal target for triggering a cancellation charge.
The owner had also spoken with the therapist. To her, it was unclear that fiance had miscarried during our appointment (rereading my email to her, I did say it happened at 9:30pm instead of 9:30am - I was tired, stressed, and concerned about fiance, but I also said it happened during our appointment time).
Still, the simple fact that we were dealing with a miscarriage and had to cancel last minute due to health concerns surrounding it deserved some leniency.
At that point, he made it clear that they would refund the cancellation charge. He also acknowledged that if we wished to seek counseling elsewhere, he understood and could provide a referral.
I told him that I appreciated his follow up and can understand how therapist may have been confused regarding the situation. That said, there were no follow up questions or clarifications requested on her part. I also told him that up until this point, we had been happy with her service.
Ultimately, I think the experience soured us enough (fiance said that at times, she just wanted to say 'f this therapist) that we'd likely have trust issues moving forward. So I just submitted an email severing our professional relationship. This sucks, though, because now we have to go out and find a new therapist.
Thank you to everyone who expressed their condolences prior to offering their two cents.
And if you're a therapist who enforces the cancellation charge no matter what (even under the stipulation that becoming the arbiter of what deems something a medical emergency is a slippery slope)...
consider what your clients would think if you said 'I understand that your fiance miscarried during our appointment time and that you haven't missed an appointment previously, but a contract is a contract.
Readers continued to weigh in on OP's update:
semoli8 writes:
'I understand that your fiance miscarried during our appointment time and that you haven't missed an appointment previously, but a contract is a contract.'
Outlandish isn't it, and yet many of the comments on your original post actually defended this point of view. It was pretty breathtaking to witness. It did not inspire me with faith in therapy as an institution.
I'm really glad that the owner of the practice ended up using some consideration in how he applied the policy.
I can actually see how this f up might have happened: the owner informed the therapist about this policy when she was hired, maybe in writing, but didn't clarify that the therapists were supposed to use some discretion in applying it. She assumed it was black and white.
That said, she should have been absolutely appalled at "having" to charge you for a session you missed due to your partner's miscarriage.
She should have felt badly enough about it to start seriously wondering whether there was a way she could avoid charging you. This line of thought would have led her to ask her boss, who would have told her not to enforce the policy.
But she never got that far, because she didn't think or feel deeply enough about what you guys were going through. Eh, patient cancelled last minute, email says something about a miscarriage, I'll charge the fee and move on.
That's an insane level of detachment for a person with whom you're sharing your most intimate feelings and troubles. I mean, you would likely have gotten more compassion from a hair salon or a chiropractor's office.
Good on you guys for moving on, wishing you the best going forward.
kakakatei7 writes:
When you charge people a cancellation fee for something like this (a rare medical emergency), then you encourage people to show up while undergoing a medical emergency.
I have a feeling that the therapist wouldn’t be pleased to have a woman actively miscarrying in her office during a session (or a patient contagious with Covid, or a patient with an untreated broken bone crying in pain).
It’s a bad policy that creates bad results, and I don’t blame OOP’s fiancée for feeling like the trust was lost in that counseling relationship.