Larsen’s December letter revealed that the state’s largest insurer, Blue Cross Blue Shield of Florida, spent 79.2 percent on healthcare for individual policies in 2010, and if refunds had been offered then, it would have had to give back $8 million. Golden Rule, a subsidiary of UnitedHealthcare, spent 67.5 percent of its premiums on healthcare and would have to give back $36.8 million. Humana spent 62 percent, for a refund of $27.7 million. Cigna was at 65.8 percent, for a refund of $11 million.

Insurers are still calculating their 2011 loss ratios, the percentages that will determine refunds. Ellen Laden, spokeswoman for Golden Rule, said insurer reports were due to HHS by June 1, with refunds to consumers by Aug. 1.

BCBS spokesman John Herbkersman said the nonprofit company is “fully committed to providing quality and affordable healthcare and will continue to comply with all regulatory guidelines established by the federal government.”

One agent complaining to Washington was Stan Bershad, who runs a four-agent practice in Bay Harbor Islands. He wrote that he used to receive $75 a month from Aetna for selling a policy to a small law firm in Fort Lauderdale. Recently, he saw that reduced to $3 a month — for a policy that took him hours annually to service.

Bershad said in an interview that he’s convinced his pay was slashed because Aetna wanted to change its loss ratio to comply with the law.

BCBS and many other insurers now use the Internet to sell individual policies, and Santiago Leon, a Miami health insurance broker, said the law may put almost all agents out of business, the same way the Web ruined many travel agents.

McCarty said that would be unfortunate. Individual health insurance is sold by “mom and pop stores” that do a valuable job of helping clients choose among the many options in health plans and help clients when they encounter problems with insurers. “Buying a ticket to Atlanta is not the same as buying health insurance,” he said.

Rome, the consumer advocate, said he agreed that agents provided valuable services. He suggested clients who want those services should pay agents directly, rather than as an insurance commission. Bershad, who’s been an agent for 44 years, said that would be a “difficult transition.”