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$20 for missed or 10-15+ minutes late in US is not abnormal.
The office doesn't get paid if you don't show up so it makes sense. Idk why so few people understand that concept.
You wouldn't show up to work for an hour, be unpaid, and be happy about it.
Therapists charge > $60 for a missed session.
Then you show up on time and the doctor is "behind" because someone else was late and you end up waiting well past the "late arrival" time as if your time isn't also valuable.
While annoying - that's a completely separate issue.
Though it's probably why they only charge $20 when insurance is definitely paying more than that.
I guess that's why Therapists/Psychiatrists will charge a full fee because there is no queue like that. It's truly 1 full hour wasted. Nobody is going to show up early to fill the slot.
Mine is usually the whole copay...