My HMO won't Pay Service Provider?

[cyberized]

Hello there, I live in Oregon and am retired on small Disability Pension, I have paid monthly for Health related coverage from an HMO for years. Last year I switched HMOs but was told and read where they, like my previous HMO, provided Eye Exam and New Glasses ($10 Co-Pay) like once every 2 years - anyway - I needed new glasses so I located an accepted Service Provider and went for my appointment. The girl took my HMO card and called to verify approval and after she was assured I was covered there - I received my exam etc. and paid my co-pay.
About a month later I received announcement from my HMO that they refused to pay for my exam - - - I called both my HMO and the Optomertist Office; the HMO said that the O.D. that gave the exam was NOT previously approved by them (when they approved the OFFICE (provider) he was not employed by them. The Optomertist rep. told me not to worry that they would work it out with my HMO. I again received a notice that my HMO refused to pay that service provider; then I received another HMO refusal to pay the specific Dr. himself. I knew what was coming next, sure enough, today I received a BILL for the service myself, it is in/for the Dr.'s name.
Prior to receiving this bill I swore if I did get this bill I would NOT pay it - I'd make them take me to court first. I feel that morally and legally they are responsible for this - I was told by them that I was covered for this service they provided - now they tell me I AM RESPONSIBLE for what my HMO does not agree to pay. Were not they responsible to know this prior to providing me the service?
Now that they have billed me - I cannot or do not want to go thru all the stress etc. caused by fighting with them so I will reluctantly GIVE them their $66 and have $34 to eat on the rest of the month.
Just kind of interested what someone in "the know" here might have to say about the LEGAL aspect of this (am I right - or are they - or are we both right - I did receive the service BUT.......)

TKS Michael

 

[ALawyer]

Sometimes it tests the courage of your convictions to stick to a course of conduct you started out on.

YOU are not at fault, the HMO and/or Office of the OD is. I would not pay the Bill, at least not in full, as you relied on his office to your detriment.

They may never sue you for so pidling an amount (to them) and if they did, your detrimental reliance may be a defense to the claim -- a lawyer would have to review all the paper, and that's not worth it for $100.

Consider offering 40 cents on the dollar demanded, and be prepared to split it 50-50 if you'd rather end the hassle.

 

[cyberized]

Thanks ALawyer

Dear ALawyer,
Thank you for the good response to my post about my situation ---- I have not yet sent them off a check and am further contemplating doing just what you suggest --- returning to plan A: and REFUSE to pay anything, especially now that you do confirm what I thought - that legally I owe them nothing (I still believe the HMO owes the O.D. - not me)

TKS Michael