Free consultation and free first visit offers: what a medical practice can advertise

A med spa advertises a free consultation for injectables. A dental office offers a free implant consultation with a scan. An orthopedic practice runs a free first visit for knee pain. A weight management clinic offers a free virtual consult. Each one is the same promise to a patient: you can come in and pay nothing. Whether that promise is true, and whether the practice may make it at all to Medicare and Medicaid patients, depends on what the visit includes, who gets billed and what happens after it.

This guide covers the free consultation or free first visit as an offer in your ads, on your website and in your booking flow. Chiropractic offers, including free exams and X-rays, have their own chiropractic new patient offers guide. Rides, parking and other help to reach the office are covered in our guide to free rides and patient support perks, matching a competitor’s price in our guide to price matching and competitor coupons, and gifts and points in our patient loyalty and rewards guide. For refund promises attached to an offer, see our guide to money-back guarantees in healthcare ads. For deadlines on offers, see our guide to countdown timers and limited-time offers. For running an offer as a post on your Google profile, see our guide to Google Business Profile posts and offers. Free product samples and free trials of products you sell are covered in our guide to free samples and trial offers for health products.

The short version

• Free has to mean free. The FTC guide on the word says the terms and conditions of a free offer should appear at the outset, in close conjunction with the offer, and that an asterisk to a footnote is not disclosure at the outset (16 CFR 251.1(c)).
• If an insurer or another third party is billed for the visit, it is not free. Texas lists claims of free service when a third party is billed as false, deceptive or misleading advertising for physicians (22 TAC 164.3(b)(5)).
• In Florida, an ad for a free, discounted fee or reduced fee service, examination or treatment by the listed licensees, including physicians, chiropractors and dentists, must carry a 72 hour statement in capital letters (Fla. Stat. 456.062).
• For Medicare and Medicaid patients, a free service is remuneration under the beneficiary inducement law, and an advertised free visit is the kind of offer the law is aimed at (42 USC 1320a-7a(a)(5), (i)(6)). OIG’s nominal value line is 15 dollars per item and 75 dollars per patient per year (OIG, December 7, 2016).
• Write down what the free visit includes, what it does not, and what the next step costs, and put that next to the offer.

What “free” has to mean

The FTC Act prohibits unfair or deceptive acts or practices in commerce (15 USC 45(a)(1)). The FTC’s guide on the word free sets out how the Commission reads free offers. It was written for a free item that comes with a purchase, and its main points carry over to a free visit that is meant to lead to paid care.

• No hidden recovery of the cost. A purchaser has a right to believe the seller will not directly and immediately recover the cost of the free item or service by marking up the price of what must be bought, by substituting something of lesser quality, or otherwise (16 CFR 251.1(b)(1)). A free consultation followed by a treatment plan priced higher than the practice’s regular price for the same treatment runs into that.
• Conditions up front. All terms, conditions and obligations should be stated clearly and conspicuously at the outset of the offer, in close conjunction with it. A footnote reached by an asterisk is not disclosure at the outset (16 CFR 251.1(c)).
• A regular price must exist. When free is tied to a purchase, the guide measures it against the regular price, meaning the price at which the service was openly and actively sold in the area for a reasonably substantial period, such as 30 days (16 CFR 251.1(b)(2)).
• Not forever. So that a free offer stays special, the guide says a single kind of service should not be advertised with a free offer in a trade area for more than 6 months in any 12 month period, with at least 30 days between offers and no more than three offers in that area in 12 months (16 CFR 251.1(h)).

No federal rule defines what a free consultation at a medical practice must include. We recommend writing it down: who the patient sees, how long the visit is, and whether it includes an exam, imaging, lab work or a written plan. If the visit includes a scan, a photo analysis or a test you charge for elsewhere, say whether that is part of the free visit.

If you bill insurance, it is not free

A visit billed to the patient’s insurer is paid for, even if the patient owes nothing at the front desk. The patient may still owe a copay, coinsurance or a deductible, and the visit counts against their plan.

• Texas. The Texas Medical Board rule lists, among false, deceptive or misleading advertising, providing untruthful or deceptive claims regarding costs and fees, including claims of free service if a third party is billed (22 TAC 164.3(b)(5)).
• FTC guide. The guide says free indicates the buyer is paying nothing for that item (16 CFR 251.1(b)(1)). A patient who later receives a bill or an explanation of benefits for the free visit has been told something that was not so.

No federal rule says how to handle a patient who wants the visit billed to their plan. We recommend picking one path for each offer: either the visit is free for each patient who books it and is not billed to anyone, or it is a normal visit billed to insurance and the ad does not call it free.

Florida’s 72 hour statement

Florida requires a set statement in any advertisement for a free, discounted fee or reduced fee service, examination or treatment by a health care practitioner licensed under the chapters listed in section 456.062 of the Florida Statutes. The list includes medical practice (chapter 458), osteopathic medicine (459), chiropractic medicine (460), podiatric medicine (461), optometry (463) and dentistry (466).

The statement must appear in capital letters clearly distinguishable from the rest of the text. It reads: THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT (Fla. Stat. 456.062).

The statute has one exception: an ad in a classified directory whose primary purpose is offering products and services at free, reduced or discounted prices, where the statement appears prominently in at least one place in the directory. The statute does not exempt websites, social posts or search ads, so we recommend putting the statement on each of them when the offer runs in Florida, and planning for the 72 hour window in your scheduling and billing: a patient who has a paid procedure within 72 hours of responding to the ad can refuse to pay for it.

Medicare and Medicaid patients: the beneficiary inducement law

Federal law sets a civil money penalty for offering or transferring remuneration to a person eligible for Medicare or a state health care program that the offeror knows or should know is likely to influence the person to order or receive, from a particular provider, practitioner or supplier, any item or service Medicare or a state program may pay for (42 USC 1320a-7a(a)(5)). The statutory amount is up to 20,000 dollars for each item or service, plus other sanctions the section allows (42 USC 1320a-7a(a)). HHS adjusts this amount for inflation each year in the table at 45 CFR 102.3, so read the current table rather than the figure in the statute.

• A free service is remuneration. The statute defines remuneration to include transfers of items or services for free or for other than fair market value (42 USC 1320a-7a(i)(6); 42 CFR 1003.110).
• Advertising is the trigger, not the cure. OIG says the inducement element is met by any offer of valuable, meaning not inexpensive, goods and services as part of a marketing or promotional activity, active or passive (OIG Special Advisory Bulletin, August 2002).
• The nominal value line. OIG reads inexpensive or nominal value as a retail value of no more than 15 dollars per item or 75 dollars in total per patient per year, and says the items may not be cash or cash equivalents (OIG Policy Statement, December 7, 2016). In 2002, OIG said that unless a practice fits an exception or has a favorable advisory opinion, gifts or free services to beneficiaries should stay under the nominal value limits, which were then 10 and 50 dollars (OIG Special Advisory Bulletin, August 2002).
• The financial need exception does not fit an ad. The exception for free items or services given after a good faith finding of financial need applies only if they are not offered as part of any advertisement or solicitation and are not tied to other services Medicare or a state program pays for (42 USC 1320a-7a(i)(6)(H)).

The text of section 1320a-7a(a)(5) reaches items and services Medicare or a state program may pay for. A free consultation for a service no program covers, such as a purely cosmetic procedure, sits outside that text on its face. A visit that can lead to covered care, such as a skin check that finds a lesion, a dental exam for a Medicaid patient, or a knee evaluation that leads to imaging, is inside it. We recommend having your attorney review the offer before it runs to people who can be Medicare or Medicaid patients.

The Anti-Kickback Statute is a separate law. It makes it a felony to knowingly and willfully offer or pay remuneration to any person to induce them to purchase or order a service a federal health care program may pay for (42 USC 1320a-7b(b)(2)(B)). Our healthcare marketing rules guide explains how the two laws fit together.

Consultation, exam or treatment: say which

A patient reads free consultation, free exam and free first visit as different promises. No federal rule defines the terms for practices, so the clearest offer names what happens in the room. We recommend:

• A consultation that is a conversation: who the patient meets, for how long, and that no exam, imaging or treatment is included.
• An exam: what is examined, and whether imaging, lab work or photos are included or charged separately, with the price.
• A virtual consultation: that it is by video or phone, and that any test, prescription or procedure is a separate paid service.
• The price of the next step, or a link to your price list, on the same page as the offer. Our guide to advertising cash prices covers how to show prices clearly.

The visit after the free one

The free visit is where the offer meets the patient. A patient who came in for free and leaves with a same day procedure, a signed financing agreement or a prepaid package has spent money at a visit that was sold as costing nothing. If the free visit is mainly a route to a paid upgrade, read our guide to bait and switch in healthcare ads as well.

• Same day treatment. In Florida, a patient can refuse to pay for any other service, examination or treatment performed as a result of and within 72 hours of responding to the ad (Fla. Stat. 456.062). Outside Florida, no federal rule sets a waiting period. We recommend telling patients in writing that they do not have to decide or start treatment at the free visit.
• Packages and financing. Prepaid packages and financing offered at the free visit carry their own rules. See our guides to advertising patient financing and membership auto renewal rules.
• The price of what is recommended. If the treatment plan costs more than the practice’s regular price for the same service, the free visit was not free in the FTC’s sense (16 CFR 251.1(b)(1)).

Questions to ask before you advertise a free consultation

• Is the visit free for each patient who books it, with no bill to the patient or to any insurer?
• Does the offer reach people who can be Medicare or Medicaid patients, and can the visit lead to care those programs pay for?
• What does the visit include, and is each excluded item named next to the offer?
• Do we run the offer in Florida, and does each ad carry the 456.062 statement?
• Do we run the offer in Texas, or in another state whose board rules limit free offers?
• Is our treatment plan priced at our regular price for each service?
• How long has the offer run in the last 12 months?
• Does our state board for dentistry, chiropractic or our other license add its own rule?

Use and avoid

• Use: “Free 20 minute consultation with a nurse injector. No exam or treatment at this visit. Treatment prices are on our price list.”
• Use: “Free consultation. We do not bill your insurance for this visit.”
• Use: the Florida 72 hour statement in capital letters, on the ad itself, when the offer runs in Florida.
• Avoid: “Free consultation” when the visit is billed to the patient’s plan.
• Avoid: “Free exam*” with the conditions in a footnote at the bottom of the page.
• Avoid: a free visit offered to Medicare or Medicaid patients without an attorney’s review.
• Avoid: “Start your treatment today” on a free consultation page.

An illustration

This example is invented. [Practice name], a dermatology practice in Florida that bills Medicare, wants to advertise free consultations for its cosmetic laser services. Its first draft ad says “Free skin consultation*” with a footnote saying imaging is extra, and the front desk plans to bill the visit to insurance when a skin concern comes up.

Before the ad runs, the practice rewrites it as “Free 15 minute cosmetic laser consultation. Not billed to insurance. Skin imaging is not included.” It adds the 456.062 statement in capital letters below the offer and on the landing page, and lists the price of each laser treatment on the landing page. The practice decides with its attorney that medical skin checks are not part of the offer and are booked as normal visits. Staff are told not to schedule a laser treatment on the day of the consultation, and the consent form for any treatment within 72 hours mentions the patient’s right under the statute.

Checklist

• Write down what the free visit includes and excludes.
• Decide that the visit is not billed to anyone, or drop the word free.
• Put each condition next to the offer, not in a footnote (16 CFR 251.1(c)).
• Price the next step at your regular price and show it.
• Check the offer with your attorney if it reaches Medicare or Medicaid patients (42 USC 1320a-7a(a)(5)).
• Add the 456.062 statement to each Florida ad, page and post.
• Check 22 TAC 164.3(b)(5) for Texas physicians and your own state board’s rules.
• Track how long the offer runs in each 12 month period (16 CFR 251.1(h)).
• Tell patients in writing they do not have to decide at the free visit.

How we help

We build websites, local and organic search, Google Ads and lead generation and an AI front desk for independent practices. For free consultation offers, that means ads and landing pages that state what the visit includes, carry the conditions and any state statement next to the offer, and show the price of the next step. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules guide.

Sources

• 15 USC 45: Unfair methods of competition and unfair or deceptive acts or practices
• 16 CFR 251.1: FTC Guide Concerning Use of the Word “Free” and Similar Representations
• 42 USC 1320a-7a: Civil monetary penalties
• 42 USC 1320a-7b: Criminal penalties for acts involving Federal health care programs
• 42 CFR 1003.110: Definitions (remuneration)
• 45 CFR 102.3: HHS civil monetary penalty inflation adjustment table
• OIG Policy Statement Regarding Gifts of Nominal Value to Medicare and Medicaid Beneficiaries (December 7, 2016)
• OIG Special Advisory Bulletin: Offering Gifts and Other Inducements to Beneficiaries (August 2002)
• Florida Statutes 456.062: Advertisement by a health care practitioner of free or discounted services; required statement
• 22 Texas Administrative Code 164.3: Misleading or Deceptive Advertising

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