It's one of the most powerful moments in one of the most talked-about movies of recent years. Early on in Michael Moore's Sicko, a health-insurance saleswoman named Becky Malke tells of taking an application from one couple who believed that they would finally be getting coverage.
"They were so happy," recalls Malke, breaking into tears. She realized from their health histories what was going to happen, but was not allowed to say. "And I thought, oh God, they're going to get that phone call in a couple of weeks telling them that they're not eligible for insurance. And I just felt so bad."
The film doesn't name the insurer or give additional information about Malke, for reasons that are painfully ironic. Malke, who lives on Madison's west side, was still employed by the company, Humana, and pregnant with her first child. She feared she'd get fired and lose her benefits. Moore, she says, offered to pay her medical bills if this happened, but she was still too afraid, so he agreed to not name her employer.
"I didn't want to lose my insurance," says Malke, who gave birth four days before the film's June 29 premiere and quit her job soon afterward. "I knew if that happened, I couldn't apply for individual insurance, because if you're pregnant, you're declined."
Yep, you read right. Being pregnant automatically disqualifies a person from individual health coverage. So is being the father of an unborn child. Companies like Humana, says Malke, won't cover babies until they're at least two months old and show no signs of serious problems.
"I almost threw up in class when I heard that one," says Malke. "I couldn't believe it."
That mixture of shock and disgust perfectly fits Moore's film - and accurately sums up Malke's view of the year and eight months she spent at Humana.
"I started realizing the profit end of it," she says. "Humana's motto is, 'Guidance when you need it most.' But when you need it most, you're not eligible."
Rebecca Malke, 28, was born in Marinette and went to school at UW-Eau Claire. After graduating in 2001, she moved to Madison to work.
Two years later, on a trip to India, Malke met her future husband, Ragu. When she went to have her teeth cleaned, he apologized for how expensive it was: $4. A full physical exam cost 75 cents - and she was told to keep her receipt, which would cover any return visits for a month.
In October 2005, Malke followed several coworkers at MCI, where she worked as a relay operator for the hearing-impaired, to job openings at Humana's Middleton office, which employs about 260 people. The pay was better than at MCI, but the health-care benefits were not as good. It cost about the same but with a higher deductible and co-pays.
Based in Louisville, Ky., Humana is a Fortune 500 company with a nationwide customer base of 11.5 million. Last year, the company reported gross profits of nearly $4 billion on $21.4 billion in revenue. 2007 is shaping up to be an even better year.
Malke was hired to do customer service, but ended up being trained in sales. The job involved fielding calls from people seeking price quotes or wanting to apply for individual coverage. (Humana also sells group coverage, for which the rules are different.) She handled up to 40 calls daily and processed maybe 30 applications for coverage per month, of which roughly a third were denied.
Applicants are asked a series of health-history questions designed to identify bad risks. One Humana trainer, says Malke, likened this to homeowner's insurance - a person who waits until his house is burning down can't get it. The analogy made her uneasy: "I thought, This is health insurance. These are people's lives."
Dozens of conditions, from diabetes to heart disease to being overweight, trigger automatic denials. So do certain jobs, like professional sports (except golf), working in oil fields or with explosives, even being a fisherman who doesn't return to port daily.
In the film, Moore presents a sprawling list of disqualifying conditions, which Malke provided. Insurers vary in the things they flag, but all seek to disqualify people who might cut into their profit margins.
"What Humana does is no different than any of the other companies," she says. In fact, "I've been told Humana is not as strict."
Besides health histories, insurance underwriters may obtain personal medical records. Denied applicants, Malke says, are reported to a national databank, in case they seek individual coverage from some other provider.
And "if by some freak chance of nature" a preexisting condition escapes notice, it will show up if the person uses the health plan to obtain medication. Then the company would cancel the policy and demand repayment for any coverage.
Humana spokesman Mark Mathis confirms that efforts are made to verify health information, although he declines to comment on specific methods, "lest someone try to take unfair advantage of that knowledge." He says one of Humana's goals "is to ensure that people represent themselves accurately and that fraud is not being committed." This is done as "a matter of fairness" to the company and its other customers.
"Everything Humana does is fairly standard" and legal, explains Mathis. "This is a highly regulated industry." He adds that Humana supports health-care reform (see ChangeNow4Health.com): "We would absolutely agree that everyone deserves coverage, without question."
Last August, Malke heard that Moore was making a new film, about the health insurance industry. She visited his website, and saw he was soliciting personal stories. She typed a note, and heard back from Moore's assistant.
A four-person crew came to Madison last December to film interviews with Malke and her husband, Ragu. A certified nursing assistant, Ragu talked about the health-care system in India. This did not make the film.
In late June, Malke attended an early showing of Sicko in Chicago. She and Moore briefly shared a spotlight. She's never heard from Humana about her role in the film.
Malke, who now works part-time at a local Unitarian Church, is covered under Ragu's policy. One thing she's learned, and wishes others would also, is to avoid any life choice that involves losing health insurance: "If you're thinking of retiring, or you're thinking of changing your job, you better call around before you make that decision."
Watching Sicko, Malke felt "just really embarrassed." When her mother-in-law in India got lung cancer, treatment to full recovery cost less than $800. She wonders why the richest nation on earth does not do as well.
"When I worked at Humana, people would get angry and say, 'Something has to be done, something has to change.' And I'd think, 'Are you going to do anything? Are you angry enough?'"