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Not paying her share troubles reader

The Baltimore Sun

You cash a check for $200, but a bank teller accidentally gives you $100 extra. Do you take it back and inform the teller of the mistake? Or do you scamper off gleefully to buy the complete set of HBO's Deadwood Season Two?

Does that answer change if it was an ATM error rather than human error?

Would you lie about a child's age to get a lower price? Change the price tag on merchandise in a store? Accept a CD from a friend who just burned a rock group's newest album on the computer?

Whether we allow ourselves to benefit or steer clear of such dubious fortune has been examined for ages by experts who study consumer behavior. Studies have shown that consumers show the greatest indifference to behaving ethically when dealing with large corporations that are often seen as greedmongers.

So imagine my surprise when I got Sylvia Merfeld's voice mail on Dec. 6:

"I owe Humana Insurance money," she said. "I love not having to pay anything for my health insurance or prescriptions, but I don't believe it's right. Can you help me?"

I called the 83-year-old retired homemaker in Pikesville and asked, "Are you pulling my leg?" She wasn't.

In December 2005, Merfeld signed up for Medicare's prescription drug plan with Humana Health Care Plans in Louisville, Ky. The plan called for Merfeld to pay a $250 deductible and then $6 would be taken out of her Social Security account every month to pay for the premium. After that, Humana would pay for 75 percent of her prescription drug costs.

Merfeld didn't think anything of it again until she went to the local pharmacy to buy some medication. Two different types of drugs she normally takes - which would usually run her $29 for a generic and another $60-plus for a name-brand - added up to just $4 for both.

"Oh my God, it was wonderful," Merfeld said, laughing. "But I knew it was wrong."

Merfeld checked her Social Security account and discovered no money had been taken out to pay for the premium. She called Humana's customer service line in June to report that something was clearly amiss.

"When I told Stewart at Humana that they weren't charging me, he was very insistent that the company and their computer was correct," Merfeld said.

"I told them they had me listed as indigent since they weren't charging me a premium and my prescriptions were only costing me $1 for generics and $3 for name-brands. They said I qualified for 'extra help.' That's wrong. As nice as it is not to pay, I can afford to pay."

"He insisted that they never make mistakes," Merfeld said.

She called six more times - once every month - to let Humana know a mistake was being made in her favor. Twice, she was assured that the problem was fixed in the computer system.

"One woman I spoke to, she said her name was LaShonta, said 'Most people would just let it ride," Merfeld said. "But it wasn't fixed so I kept calling. I just didn't want to take advantage of the system."

No, seriously. She wasn't kidding.

A couple of weeks later, I called Humana's regional communications manager, Jeff Blunt. He said he could not talk to me about Merfeld's case because of privacy laws. He did, however, agree to contact her and take care of the mistake.

Right before the yuletide holidays, Merfeld left another voice mail to say Humana had corrected the problem. On Jan. 2, Blunt e-mailed to say that "our customer service team has researched the issue and worked directly with Ms. Merfeld to achieve resolution."

But come February, Merfeld graced my voice mail with another message. She still hasn't been billed for the premium, though Humana did fix her prescription drug costs.

Humana had informed her of a rate increase in her Medicare plan that would raise her deductible by $15 a year and $7 more for the premium, and even sent her a letter spelling out how much she would be billed. This would all be well and fine, Merfeld said, if they were actually taking money out of her account.

Trying several times again, Merfeld called Humana's reps, who told her to call Social Security, which told her to call Medicare, which told her to call Humana.

Dizzying, isn't it?

"Everyone said I wasn't in their records and then told me they couldn't help me," Merfeld said. "At that point, I just gave up. I was so frustrated. I have certainly tried to fix this problem. Either someone is not getting paid or someone else is paying for me. It's crazy."

Crazy, indeed. Most people would have given up long ago. Then again, most probably wouldn't have bothered calling me. Amused by my own moral dilemma, I wasn't sure whether to tell Merfeld to take the Humana rep's advice and "let it ride" or keep trying.

My ethics got the best of me and I phoned up the Centers for Medicare & Medicaid Services.

Readers might recall that back in September, Sun financial sage Eileen Ambrose wrote about this very problem. At the time, it was believed at least 150,000 consumers electing to pay premiums through Social Security deductions were having similar complaints. The agency blamed the trouble on communication glitches between private health insurance companies, Social Security, Medicare and the Treasury Department.

"The great preponderance of those problems have been resolved," Medicare spokesman Lorraine Ryan said. "It was something that was identified by the end of last summer and we've been continually working to resolve them. But we are finding that there are still people out there who are having these problems."

Ryan said Merfeld should not be worried about the possibility of being dropped from her plan or getting whacked with a large bill for unpaid premiums. Typically, insurance companies have been working with consumers to create an equitable payment plan that those who were affected can pay with relative ease.

"If she calls us, we will open up her file to see what needs to be done," Ryan said of Merfeld.

With that, I handed over Ryan's name and number and left it up to Merfeld.

"It was good while it lasted," said Merfeld, who was planning on calling Ryan. "I know I was crazy to call you, but I just couldn't stand it anymore."

Some good consumers just don't know when to quit while they're ahead.

Reach Consuming Interests by e-mail at consuminginterests@baltsun.com or by phone at 410-332-6151. Find an archive of Consuming Interest columns at baltimoresun.com/consuming.

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