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The rule for each care profession
The common ground is the health insurer: it never pays for a session that did not take place, whatever the profession. Article 73bis of the health insurance law forbids issuing a reimbursement document for care that was not given. Beyond that, each profession has its own text, or none. Tilcao, which a care practice can ask to set up, repeats the practice’s own rule when a patient books or cancels; it never sets one.
| Profession | May the patient be charged? | On what condition | Source |
|---|---|---|---|
| GP or specialist | A reasonable compensation, never a fee | Told beforehand, at fault, a loss shown, below the consultation fee | Order of Physicians, Code article 33 |
| Psychologist, first-line convention | Yes, a compensation | Rules explained beforehand; never entered in the network’s billing software | RIZIV-INAMI circular of 6 October 2025 |
| Psychologist, private practice | As agreed | Financial terms agreed before the work starts | Psychologists’ code, article 37 |
| Physiotherapist | No specific rule | The 2025-2026 agreement says nothing on missed sessions; consumer law applies | Agreement M/25 |
| Speech therapist | No specific rule | The 2026-2027 agreement says nothing on missed sessions; consumer law applies | Agreement R/26 |
| Dietitian, podiatrist, occupational therapist | No specific rule found | Consumer law applies | None found |
GPs and specialists: what the Order of Physicians allows
A doctor cannot charge a fee for an appointment the patient did not keep, because a fee pays for care actually given. The doctor may ask a reasonable compensation if the missed appointment caused a loss and the patient was told in advance when it applies. The commentary on article 33 of the Code of Medical Deontology, in its version of 31 December 2025, sets the limits.
Later advices add four points. In January 2023 the Order said no agreement lets a doctor require a deposit as a condition for an appointment. In November 2025 it said a compensation clause must be clear, reciprocal and proportionate, and that nothing is owed when the absence is not the patient’s fault, as in force majeure. In September 2026 it called it unacceptable to make a medical appointment depend on a bank card guarantee. And since 1994 it has held that a psychiatrist or psychotherapist may not use a charge for missed sessions as a tool of the therapy.
Whether a doctor in the national agreement may ask it is not settled by any text we found. The 2026-2027 agreement, joined by 85.72% of doctors, says nothing about missed appointments; the Order classes the amount as damages, not a fee. No certificate of care is issued for it.
- No fee for a missed appointment.
- A reasonable compensation only if the doctor shows a loss.
- The patient told beforehand when it applies, for a no-show and for a late cancellation.
- Never as much as the fee for the consultation itself.
- Special circumstances the patient can point to are taken into account.
Psychologists: what the RIZIV-INAMI circular says
For first-line psychological care, the circular of 6 October 2025 to the mental health networks is explicit. A session can only be billed if it took place, and no-shows are not reimbursed by the compulsory health insurance. The clinical psychologist may charge the patient a compensation for a session missed because of a no-show, if the patient was properly told the rules beforehand. That charge may never be entered in the billing software of the network.
Outside the convention, article 37 of the psychologists’ code of ethics asks for honesty about money: the financial terms are agreed before the work starts. A missed-session rule belongs in that agreement, in writing.
Physiotherapists and speech therapists: what the agreements say
Nothing about missed sessions. The physiotherapists’ agreement for 2025 and 2026 forbids a conventioned physiotherapist from asking supplements on top of the agreed fees, with exceptions for care before 8:00 or after 19:00 at the patient’s request and at weekends or on public holidays. The speech therapists’ agreement for 2026 and 2027 has the same shape. Neither text mentions a missed session.
The sources disagree on one point. In 2019 Axxon, the physiotherapists’ association, wrote that a conventioned physiotherapist could deviate from the agreed fees for an absence not cancelled at least 24 hours ahead. We found that exception in neither the current agreement nor the 2020-2021 one. Ask your association before relying on it. A compensation that is not a fee for care stays possible under general law, on the conditions below.
What the patient must have been told, and how
Every text agrees on one thing: in advance. The patient rights law, article 8, asks every care provider to inform the patient in good time about the financial consequences of care. The Code of Economic Law adds two limits that apply to independent care providers too: a clause that fixes what the patient owes without an equal sum owed by the practice when it fails, or that clearly exceeds the possible loss, is unfair, and an unfair clause is void.
No official text prescribes the form. The Order’s answer to patients says the information may be given in writing, orally, or by pointing to the secretariat. Its 2024 advice on calls and messages lists the places a practice can use: a recorded message, the website, a notice in the practice, and the appointment confirmation. The confirmation is the one that shows this patient received the rule for this appointment.
- The notice period, the same everywhere, often 24 hours.
- How to cancel, by a route easier than not turning up, such as replying to the reminder.
- Whether a compensation applies, and how much.
- The exceptions: illness, an accident, force majeure.
- What the patient is owed when the practice cancels late without a serious reason.
How much do GPs ask, and how often do patients stay away?
There is no official amount and no official Belgian no-show rate. The Order’s only figure is a ceiling: below the consultation fee. A survey of GPs by the COFEM and FEDAC, relayed in March 2026, found that 33% of GPs already charge a compensation for repeated absences and 47% are considering it, and that €10 to €20 is generally seen as acceptable. The number of respondents was not given.
In April 2026 the federal health minister called GP no-shows a real problem when asked in parliament, and the trade press reported that no federal framework is planned in the short term. The often-quoted rates come from France: the French Order of Physicians says 6 to 10% of patients miss their appointment each week, and Doctolib measured 2.6% at GPs in 2024. Neither is a Belgian figure.
A notice you can adapt for a GP, physio or psychology practice
Replace everything in square brackets and use one notice period everywhere: in the confirmation, on the website, in the waiting room and in the phone message. If the practice charges nothing, delete the optional sentence; a clear cancellation rule is worth publishing anyway. A dental version, with a letter after a first missed appointment, is in missed appointment fees for dentists.
Missed and late-cancelled appointments. Your appointment is reserved for you. If you cannot come, let us know at least [24] hours ahead by calling [phone number], by replying to your confirmation or reminder, or [online cancellation link].
[Optional] If you do not come and have not let us know at least [24] hours ahead, we may ask a compensation of [amount] for the reserved time. It is not a fee for care: your health insurer does not reimburse it and no certificate of care is issued. We do not ask it if you were ill, had an accident or another reason beyond your control. If we cancel your appointment less than [24] hours ahead without a serious reason, [what the practice offers the patient].
Check the wording with your professional association or circle before you publish it: the Order of Physicians for doctors, the Psychologists’ Commission for psychologists, Axxon or your professional union for physiotherapists.
What reduces no-shows instead
An easy way to cancel and a reminder before the appointment. The Order of Physicians named both as effective tools in 2023, and in 2025 it added that awareness has to go together with a simple cancellation process. A compensation for one missed slot is a small sum, and a patient who refuses to pay can only be made to pay in court.
The time comes back when the freed slot goes to someone who is waiting. That is the work Tilcao does in dental practices, and can do in other care practices on request: it confirms, reminds, takes the cancellation at any hour, and offers the slot to the waiting list. It never invents or applies a fee; if the practice has a rule, it states it in the practice’s words.
Questions practices ask
Can a GP in Belgium charge for a missed appointment?
Not as a fee and not through the health insurer. A GP may ask a reasonable compensation if the patient was told the rule beforehand, did not come or cancelled too late without a good reason, and the GP lost time. Under the Order of Physicians’ commentary on article 33 it may never reach the consultation fee, and special circumstances must be taken into account.
Can a psychologist charge for a missed session?
Yes, if the rules were explained beforehand. For first-line psychological care, the RIZIV-INAMI circular of 6 October 2025 says no-shows are not reimbursed, the psychologist may charge the patient a compensation, and the charge may never go through the network’s billing software. In private practice the financial terms are agreed before the work starts, under article 37 of the psychologists’ code.
Can a physiotherapist charge for a no-show?
No text specific to physiotherapy says so. The 2025-2026 agreement says nothing about missed sessions, and the health insurer never pays for a session that did not take place. A compensation agreed in advance, reasonable and reciprocal, stays possible under general consumer law. Check the wording with your association.
How much may a GP charge for a no-show?
No official amount exists. The Order of Physicians says it must stay reasonable and below the consultation fee. A 2026 survey of GPs found €10 to €20 is generally seen as acceptable. Under the Code of Economic Law, an amount that clearly exceeds the possible loss is an unfair term and void.
Does the health insurer pay anything for a missed appointment?
No. Article 73bis of the health insurance law forbids issuing a reimbursement document for care that was not given, for every care provider. Any compensation is a private matter between the practice and the patient, paid in full by the patient.
Does Tilcao charge patients who miss an appointment?
No. Tilcao never invents a fee and never enforces one. If the practice has a missed-appointment rule, it states it in the practice’s words when a patient books, confirms or cancels. What it does is make cancelling easy and offer the freed slot to the waiting list. It runs in dental practices today; other care practices can ask for a setup.