Brokers Got to Eat Too?

The more you look at the healthcare system the sicker you get. We all know how PBMs drive up the cost of medicine. But what about insurance? Yup, it happens there, too. I never even heard of brokers before I entered the direct primary care world. Then I started seeing these leeches try to attach to me. They would talk about all these patients they were going to bring my way by convincing employers how good we were. I remember one dude promising me 300 patients right off the bat. “Wow!”, I thought, “Someone gets us”. The funny thing is that it would only cost me $5 per member per month. WTF? And that was forever. This dude was going to do a modicum of work and then cash in for a lifetime. I wrote him a nice email stating that if he wants the employer to give him some money then that would be fine but it wasn’t going to come from me. He didn’t even respond and I never heard from him since. That was four years ago.

I guess what I am trying to say is that I wasn’t surprised to see this article on NPR.org called Insurers Hand Out Cash and Gifts To Sway Brokers Who Sell Employer Health Plans. Here is a quick summary:

Here’s how it typically works: Insurers pay brokers a commission for the employers they sign up. That fee is usually a healthy 3 to 6 percent of the total premium. That could be about $50,000 a year on the premiums of a company with 100 people, payable for as long as the plan is in place. That’s $50,000 a year for a single client. And as the client pays more in premiums, the broker’s commission increases. 

Commissions can be even higher, up to 40 or 50 percent of the premium, on supplemental plans that employers can buy to cover employees’ dental costs, cancer care or long-term hospitalization. 

Those commissions come from the insurers. But the cost is built into the premiums the employer and employees pay for the benefit plan.

Now, layer on top of that the additional bonuses that brokers can earn from some insurers. The offers, some marked “confidential,” are easy to find on the websites of insurance companies and broker agencies. But many brokers say the bonuses are not disclosed to employers unless they ask. These bonuses, too, are indirectly included in the overall cost of health plans.


This is a lot of freaking money. Add to this trips to Bermuda, fantasy baseball camps, and tons of other prizes and it makes you wonder why doctors get in trouble for taking a drug rep pen.

Listen, I don’t begrudge how brokers make a living. I get it to a certain extent. The fact that it drives up costs, and the scumbag insurers have no problem with it, because they pass the cost on to the employees, make me sick.

For my DPC peeps, DO NOT USE brokers! If you have to then DO NOT PROMISE TO GIVE THEM PART OF YOUR MONTHLY FEE!

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]