What has to be true before any agency can help
LegitScript certification and Google Ads certification, both of which gate the category and take weeks. A landing page for each level of care you are advertising, rather than the homepage. Call tracking, because most of this traffic converts on the phone. And a phone that gets answered during the hours the ads run.
An agency that inherits an account without those spends your budget while it waits for them to exist. An agency that does not raise them on the first call has not run this category.
Fix the phone first. It is free and it changes the return on every dollar spent afterward.
When to keep it in-house
One location, one or two levels of care, a stable service line, a modest budget, and somebody on staff with a few hours a week and an interest in learning. That account is manageable: exact-match keywords on level of care plus city, a tight radius, call extensions, an ad schedule matched to when the phone is answered, and a negative keyword list reviewed weekly.
The failure mode in-house is neglect rather than incompetence. Accounts run by a marketing coordinator who also handles events and the newsletter drift, and a drifting account leaks money into broad match and geography you do not serve.
The accounts we take on run $50,000 to $100,000 a month in paid search. A program spending a small fraction of that is usually better off running it in house and putting the difference into media.
When an agency pays for itself
Multiple locations competing for overlapping geography, several levels of care with different economics, out-of-network programs advertising outside their metro, or census that swings seasonally and needs the budget moved every month. Each of those is a full-time attention problem rather than a knowledge problem.
The other case is instrumentation. Connecting call tracking to a CRM and pushing offline conversions back into Google Ads, so bidding chases admissions instead of form fills, is a build rather than a setting. Most in-house teams never get to it, and until they do, smart bidding spends your money on the wrong outcome.
The fee math is straightforward. If an agency removes more waste than it charges, or produces admissions at a lower cost per admission than you can, it pays. Ask them to show that arithmetic on an existing account. typical percentage of spend wasted in accounts we take over — verify with Tim
Questions that expose an agency in thirty minutes
What is cost per admission in your other treatment accounts, and how do you measure it? An agency without an answer has never connected an ad click to an admission. Who owns the Google Ads account, and what happens to the historical data if we leave? The answer should be you, and you should keep everything.
Do you buy or resell leads? In addiction treatment, arrangements that pay per referral or per admission run into EKRA, and you do not want that structure inside your marketing contract. How many other treatment centers do you run in my metro, and are we bidding against each other? Ask directly.
Who does the work day to day, and how often do they listen to call recordings? Nobody who has not listened to your calls can tell you whether a campaign is producing patients or vendors.
Red flags
Reporting built on impressions, rankings, and click-through rate with no line for calls or admissions. Guaranteed placement, which nobody can offer. A twelve-month contract with no exit and no performance clause. Refusing to run the ads from your own account.
Also: anyone who promises to have you advertising next week without asking about LegitScript, and anyone whose plan starts with a website rebuild before a single page has been added.
One more, harder to spot. An agency that never tells you no is managing the relationship rather than the account. The useful ones argue with you about budget and tell you when a campaign should be turned off.