Thousands of low-income patients who went to a Maryland hospital because of a heart attack or car accident years ago likely don’t know they’re owed a refund.

By the time they get offered the money, the details of the emergency visit may also be fuzzy. They may toss whatever letter they get in the mail.

It’s been two years since the General Assembly ordered nonprofit hospitals to give back the money they collected from their poorest patients between 2017 and 2021. Hospitals were supposed to treat those patients at no cost in exchange for a tax break, but charged them anyway.

What has happened since the law passed in 2022 has involved multiple state agencies, dozens of hospitals, a couple of work groups and one big flow chart. Hospital and commission officials have to figure out how to find the patients owed refunds without violating the privacy laws that protect their health and income data.

The Baltimore Banner thanks its sponsors. Become one.

At this point, it looks like refund checks would arrive eight years after the first patient paid their hospital bill.

“The goal, barring unforeseen circumstances, is to send letters to patients late this year or early next year,” said Megan Renfrew, a deputy director of the Health Services Cost Review Commission, a state agency heading the refund effort.

Lawmakers ordered the refunds after learning hospitals may have charged up to 60% of the patients who should have received free or discounted care in 2017 and 2018. A state report estimated that about 1% paid all or part of their bills, totaling some $120 million during those years.

The commission said officials don’t know yet know how many patients are due refunds or how much money they will get. The law only applies to patients who should have gotten free care, determined by how close their income is to the federal poverty level.

Hospitals say they continue to work on the refunds.

The Baltimore Banner thanks its sponsors. Become one.

“We are actively engaged in the process driven by [the commission] guidance and are partnering to see that eligible patients receive refunds as quickly as possible,” said Melony Griffith, president and CEO of the Maryland Hospital Association, in a statement.

The legal barriers have proven difficult to bypass.

Hospitals routinely use outside contractors for administrative tasks, and sharing income information with them is a legal no-no, said Renfrew. Federal and state laws protecting taxpayer data, needed to confirm a patient’s income, also are tight.

Commission officials said the hospitals were going to have to set up separate systems to avoid contractors, who are routinely used to crunch data and even print letters. That could involve a lot of manual labor, and mean a lot of errors.

To get around all this, the commission came up with a plan where hospitals could send patient names to one of three state agencies.

The Baltimore Banner thanks its sponsors. Become one.

The Department of Health or the Department of Human Services could verify patients qualified for free care in specific years because they also qualified for food or other assistance those years. The comptroller’s office would have income tax returns.

A patient would get a letter from one of those three agencies and then have to authorize sharing their information with a hospital, which would send a refund check.

The scenario is complicated and the delays are not ideal, according to Marceline White, executive director of the advocacy group Economic Action Maryland, which pushed for the law.

“We are the first state to ever do something like this,” she said. “Obviously, for people who were charged and shouldn’t have been, any amount of time is going to be too long.”

But she said now that there is a process, she envisions seeking an annual review of hospitals’ billing to ensure patients are not overcharged.

The Baltimore Banner thanks its sponsors. Become one.

“Maybe lawmakers can add years to the window or some kind of annual accountability since the system will be in place,” White said. “Also, other states will learn from our trials and tribulations” and could use Maryland’s model to repay patients.

Still to be worked out is the language in the letters sent to patients, many of whom may not recall having paid a hospital bill or multiple bills and might consider the mailing to be junk or a scam.

Renfrew said the commission is still working on that.

Meredith Cohn is a health and medicine reporter for The Baltimore Banner, covering the latest research, public health developments and other news. She has been covering the beat in Baltimore for more than two decades.

More From The Banner