New Member Payment Reminders

A new ACA plan doesn't start until the member makes their first payment (the binder payment). If that payment never comes through, the plan never goes live, and you've lost the enrollment. This campaign has the AI call new members whose plan is still pending, explain what that means, and get them on with your team if they need help paying.

It's not a collections call, just a quick two-minute check-in. The AI never takes payment info itself, and it makes a point of telling members you'll never ask for it over the phone.

In the messages below, anything in brackets fills in for each member: [First name], [AI name] (whatever you've named your AI employee), [Agent name], [Agency], [Carrier], [Effective date], and [Agency phone] (your agency's number).

In the template picker, this one's called ACA New Member Payment Reminders.

At a glance

How people get in

There's no automation with this template, so you add people yourself, usually from a list of new members still waiting on their binder payment. See Add Customers to a Campaign.

What the AI says

The campaign comes with three AI employees.

Daytime calls (the main one)

The call opens with:

Hey is this still the right number for [First name] [Last name]?

Once they confirm, the AI gives the whole reason in one connected run, like a person would:

okay nice, thank you [First name]. So yeah I'm [AI name] I'm your assigned member care specialist with [Agency], oh and this is a recorded line. but yeah anyways I see here one of our agents recently got your health insurance set up, and uh, and I was giving you a call cause it says here that your plan is still pending. Which basically just means we need to get that first payment sorted before your coverage kicks in on, let me see here uh, yeah it goes live on [Effective date]. Have you had any issues making the payment or anything?

If they ask who's calling first, it answers that ("Oh yeah sorry 'bout that, I'm [AI name]...") before getting into it.

From there:

• They haven't paid. "oh yeah no worries at all. want me to grab someone from our team who can help out?" If they say yes, it gets them on with your team.
• They already paid. "oh nice okay, my system's probably just a little behind then. well hey thanks for staying on top of it, let me go ahead and make a note here." Then it moves on to wrapping up.
• They're confused. It slows down, breaks it into smaller pieces, and checks in: "am I making sense so far?"

Before it lets them go, it always says:

alright cool, and hey before I let you go I always gotta say - we'll never ask you for payment info over the phone. If someone does, that's probably a good sign that you should hang up. And uh, is there anything else I can help you with before we wrap up?

Then it asks "do you have our number?", reads it only if they need it ("need me to say it again?"), and signs off with "alright sweet well it was great chatting with you, take care."

It's also set up for:

• "What's the issue?" "Yeah so it's just showing that that first payment hasn't come through yet, so the coverage is still pending."
• They're skeptical it's legit. "oh yeah I totally get it. So yeah I'm not asking for any money or anything like that, I'm just calling to make sure you know about the first payment and how to take care of it." If they push: "no worries at all, and you don't gotta share anything you're not comfortable with. If you ever wanna verify, you can always just call us directly."
• "Are you AI?" It's honest: "yeah so I'm actually an AI, but I've got your actual account pulled up right here so I can help out. is that ok?"
• They want to cancel, or have plan questions (copays, doctors, subsidies, networks). It never guesses and doesn't try to save it. It offers a transfer: "oh for sure - lemme get you on with one of our team members, they've got your plan details pulled up so they can walk you through everything. Okay if I transfer you here?."
• Busy right now. "oh yeah for sure no worries, when works better for you?"
• Someone else answers. It doesn't discuss plan details with anyone but the member.

The script also has a list of other things that get a transfer, like ID cards, billing disputes, account changes, Special Enrollment Periods, subsidies, and the 1095-A.

After hours

When a member calls back after hours, the after-hours employee picks up with "Hey thanks for calling me back. Is this [First name]?" It runs the same explanation (with "I was actually trying to reach you earlier" instead of "I was giving you a call"), but since the office is closed, anything that would be a transfer turns into a booked callback:

oh yeah no worries at all. so our office is actually closed right now, but I can get you set up with a callback from one of our team members during business hours and they can walk you through it. want me to go ahead and book that?

Same "we'll never ask for payment info" reminder at the end.

Appointment callbacks

When an appointment comes up, what happens depends on your appointment configuration. If the AI makes the callback, it introduces itself, mentions the recorded line, says they had a callback scheduled with your member care team, and checks that now still works. If it does, it transfers them: "okay cool, let me get you on with the team right now, just hang on one sec." If not, it rebooks and confirms the new time: "alright you're all set - so someone's gonna give you a call then."

The cadence

Day 1: Call

Text, a few minutes before the call:

Hi [First name], this is [Agent name]'s team at [Agency]. We're about to give you a quick call about your new health plan with [Carrier] - just a heads up so you know it's us!

No voicemail is written for this campaign, so nothing gets left if they don't pick up.

Day 1, about 4 hours later: Call

Text, a few minutes before the call:

Hi [First name], we tried you earlier - just following up from [Agency]. Your [Carrier] coverage is still pending that first payment. Quick call coming your way.

If they didn't connect, this text goes out right after:

Looks like we missed you! Just a reminder your coverage kicks in on [Effective date] once that payment's through. You can always call us at [Agency phone].

Day 2: Call

Text, a couple minutes before the call:

Hi [First name], last try from [Agency]. Your [Carrier] coverage goes live on [Effective date] but only if that first payment's in. Giving you one more call.

If they didn't connect, one last text, and then the journey ends:

Hey [First name], it's [Agency]. We've been trying to reach you about your [Carrier] plan - your first payment is still pending and coverage won't kick in on [Effective date] without it. We don't want you to miss out. Call us at [Agency phone] and we can get it taken care of.

When they do connect

On any of the three calls, if they talk to the AI (whether they agree to pay, say they can't afford it, are reluctant, are confused, want to cancel, or it just wraps up fine), they get this text and the journey ends:

Hey [First name], glad we could connect. If you need anything later, you can always call us at [Agency phone].

How each call works

• If they talk to the AI, they get the "glad we could connect" text and they're done, whatever the answer was.
• If we can't reach them (no answer, voicemail, "call me later," or the call drops early), they move to the next try.
• If it's a bad number, they're stopped right away.
• If the AI books an appointment, transfers the call, or logs an inquiry, the journey ends right there. Booking an appointment ends all of that member's active campaigns.
• Do Not Call and invalid numbers stop right away.

Since everyone who connects leaves the campaign, it's worth having your team look at the calls where someone couldn't afford it or wasn't ready to pay.

Before you turn it on

• Set up your escalations in Employees > Escalations. The daytime script transfers members to your team, and the after-hours and callback scripts book times, so point Transfer Call at a transfer destination and Book Appointment at an appointment configuration. Inquiries don't need anything, they go to your Inbox and the Inquiries page and the member's assigned agent gets notified. You can't activate the campaign until Transfer Call and Book Appointment point somewhere. Heads up: these scripts don't come with the escalation section the other templates have, so when you test, make sure the transfer and booking actually fire.
• Add a voicemail if you want one. There isn't one out of the box. Add it in the Employees tab or on the call steps in the Pulse tab.
• Register for SMS. This campaign texts, so you need SMS registration (10DLC) before the texts can send.
• Check your member data. The script needs first and last name, carrier, and effective date. Anyone missing one of those gets skipped, along with anyone who has no phone number, or no time zone or state.
• Add your members who still owe their first payment.
• Check your caller ID. Out of the box, this campaign calls from your agency's main number (the one your Receptionist answers), so make sure you have one. You can see this on the Phone Numbers tab: Use organization main number for outbound calls is switched on. Want it to call from its own number instead? Switch that off and add a number there (you can only change it while the campaign isn't active). See Managing Your Phone Numbers.
• Know when it calls. Calls and texts only go out during your business hours and between 8 AM and 9 PM in the member's time zone.
• Test it before you go live. See Test Your Campaign.

Then click Activate on the Overview tab. Until you do, the campaign is a Draft and nobody gets called.

Changing any of this

• What the AI says: the Employees tab. See Edit Your AI with Employees.
• Texts, voicemails, and timing: the Pulse tab. Click any call or text step to edit it. See Pulse.
• Who gets in: you add people yourself, or set up an automation on the Automations tab. See Automations Explained.