Sometimes doctors and their staffs make blunders in the patient relations that seriously affect their practices. Here are some I’ve seen.

• Treating patients with insurance as a pain. I recently saw this sign in a doctor’s office: “Don’t be Abusive to Patients with Insurance Problems.”

The reason the doctor posted the sign. He said, “Those patients represent 65 percent of our practice!”

What’s surprising is the number of front desk personnel with whom I’ve spoken, who consider insurance patients a nuisance — claiming that insurance is a contract strictly between patients and their insurance companies.

Technically, of course, they’re right. But from a public relations standpoint, this standoffish attitude makes these offices very difficult to deal with and in the process, alienates many patients.

In contrast, many offices have insurance coordinators who assume the role of the patients’ advocate in such matters. They help patients understand the coverage and benefits provided by their health insurance plans. They help patients complete the forms or as a courtesy, do it for them.

When warranted, they may intercede on behalf of patients to have insurance companies reconsider claims they initially declined to pay.

Such helpfulness differentiates these offices, makes them easy to deal with, and is greatly appreciated by patients.

• Haggling over fees. A while back, I sounded an alert about a disturbing trend reported by Harris Interactive, a worldwide market research and consulting firm, that a sizeable minority of the public has begun “haggling” with physicians, dentists and hospitals to lower their bills — and approximately half of them are succeeding. The researchers predicted that as healthcare costs continue to rise, “the practice is likely to increase”.

Now, the Web site www.insure.com has posted an article entitled, “Sickened by doctor bills? How to haggle for a lower price” by Vicki Lankarge.

“According to the Foundation for Taxpayer and Consumer Rights (FTCR),” she writes, “ everything in healthcare is negotiable, even the bills from your doctor, pharmacist, and hospital. FTCR’s patient guide states: ‘You’re paying the bills, not only as a consumer, but also as a taxpayer who helps fund the medical system.’ So don’t be cowed by your doctor’s sparkling white lab coat or by your hospital’s credentials. Establish the price you believe is reasonable and go for it.”

Among the tips she offers on “how to bargain,” are the following:

“Find out what others are paying,” Then, quoting health-care attorney Deidre O’Reilly Marblestone, she adds: ‘You should never pay your provider more than private insurers pay. And insurers never pay more than one-half to two-thirds of the total amount billed.’”

“Cash talks. Offer to pay your doctor the discounted amount you both deem reasonable in cash, immediately.”

“Plead your own case. Arrange to get face time with your doctor and plead your own case for paying a lower amount.”

How do you fight this type of haggling and not give? Here’s one way to respond. Tell the haggler:

“Our fees are based on a number of factors — the time and level of skill involved, the number of services provided, the caliber of people who work with me, our facilities and equipment, and the continuing education of all staff members. If we were to reduce fees, we’d have to leave something out and frankly, I don’t know what to eliminate without compromising the quality of what we do.”

There’s no need to use these words as such. They’re just a guideline and a way to change patients’ thinking about chiropractic treatment as a “commodity” (i.e. alike in all respects, regardless of who provides it).

Important exceptions: Hardship cases may warrant special consideration. Reducing or perhaps waiving professional fees for such patients is both appropriate and commendable.

Bob Levoy is a seminar speaker and writer who focuses on the healthcare industry. His most recent book is 201 Secrets of a High Performance Dental Practice Elsevier/Mosby (January, 2005). He can be reached at 516-626-1353.