Behavioral health marketing is one of the most specialized — and most expensive — corners of the digital advertising world. Every operator we talk to has been burned at least once: by an agency that promised the moon, billed $8K/month, and produced spreadsheets full of impressions and zero admits.
The hard part is that almost every agency sounds good on the discovery call. Polished decks, confident answers, name-drop a few logos. The difference between a real partner and a generic vendor doesn't show up in the pitch. It shows up six months in, when the work has to actually fill beds.
Here are seven questions to ask on the first call. The real ones answer in 30 seconds. The rest will start improvising.
1. "What percentage of your current clients are in behavioral health or healthcare?"
The right answer is north of 70%. The actual answer most agencies will give you is some version of "we work with a lot of healthcare brands" — which usually means they have one dental office, two chiropractors, and a vet clinic. Behavioral health is its own world. The regulatory load (LegitScript, 42 CFR Part 2, HIPAA, state advertising rules), the consumer psychology (people in crisis or family members searching at 2am), and the unit economics (high LTV, long sales cycles, insurance complexity) don't translate from other healthcare verticals.
If they can't name five current behavioral health clients on the call, they're going to learn your business on your dime.
2. "Are you LegitScript certified — and can you walk me through your last LegitScript renewal?"
LegitScript certification has been required to run Google Ads for addiction treatment since 2018. If an agency doesn't know what LegitScript is, they cannot run Google Ads for you. Period.
But knowing it exists isn't enough. Ask them to walk through the renewal process — what documentation they help clients prepare, common failure points, how long it takes. Real behavioral health agencies have done this dozens of times and can rattle off the details. Pretenders will give you a one-sentence answer and change the subject.
3. "How do you handle 42 CFR Part 2 in our marketing stack?"
This is the question that ends most discovery calls. 42 CFR Part 2 is the federal rule governing substance use disorder records, and it has stricter consent requirements than HIPAA. Almost no general marketing agency knows it exists. The ones that do can tell you exactly how they handle pixels, retargeting, testimonials, CRM data, and call recordings under Part 2.
If they pause, ask "what's that?" or pivot to talking about HIPAA — that's your answer. They will set up your marketing in a way that creates federal regulatory exposure, and you'll be the one whose license is on the line.
4. "Show me a recent client report. Specifically — what's your client's cost-per-admission?"
Cost-per-lead, cost-per-click, and CTR are not the metrics that pay your staff. Cost-per-admission is. Ask any agency for a real client report and look for that number. If it's not there, ask why.
The real answer should be that the agency is matching ad spend to actual admits — pulling data from your CRM or admissions team and reporting on the metric that actually correlates to revenue. The fake answer is some variant of "we don't have visibility into your admissions data, that's on your side."
Translation: they don't know if their work is working.
5. "What's your minimum engagement length, and what happens if I want to leave at month three?"
This question filters for confidence. Agencies that lock clients into 12-month contracts with brutal exit clauses know their work doesn't speak for itself. Real behavioral health agencies are confident enough to offer month-to-month or quarterly engagements, because they know their results will keep you.
Pay attention to how they handle the question. Defensive language ("we need that runway") usually means they've lost too many clients in the first three months. The good ones smile and tell you the average client stays 2+ years.
6. "Who specifically will be on my account — and what's their behavioral health background?"
Discovery calls are sold by the principals. Day-to-day work is done by junior account managers — many of whom were running Shopify stores last quarter. Ask for the actual names and backgrounds of the people who will be touching your account. Ideally you want:
- A senior strategist who has worked in or around behavioral health for 3+ years
- A specialist (paid media, SEO, or content) with treatment-center-specific experience
- A point of contact you'll talk to weekly — not a quarterly "QBR" rotation
If the answer is vague ("we have a team that handles that"), that's the answer.
7. "If I gave you $10K this month, where would you spend it — and why?"
This is the last question, and it's the most revealing. A specialist agency can answer it in 30 seconds based on what they know about your situation. They'll talk about your geography, your levels of care, what insurance you take, your current census trends, and which channel produces admissions fastest for centers like yours.
Generic agencies will give you a textbook split: "30% Google, 30% Facebook, 20% SEO, 20% content." That's not strategy. That's a default. The right answer is custom, and it's specific to your business in 30 seconds because they've thought about businesses like yours a thousand times.
The Bottom Line
You don't need to hire the cheapest agency. You need to hire the one that's specifically built for your business — behavioral health, healthcare, treatment, recovery. The seven questions above will tell you which one is which inside of an hour.
And if you ask all seven and the answers don't add up, walk away. The right partner is out there. The wrong one will cost you a year you can't get back.
