Solved: Google Ads 'Eligible (Limited)' & No DSA Impressions

Hi there,

Thanks for reaching out! I've had a look at the challenges you're facing with your Google Ads for the healthcare business. It's a notoriously tricky sector, so don't feel like you're alone in this. I've worked on a few campaigns in sensitive industries and what you're describing is unfortunately quite common. Happy to give you some initial thoughts and a bit of a roadmap. It sounds like you're dealing with two seperate but related issues: a technical one with DSA and a policy one with the "Eligible (Limited)" status. We'll need to tackle both.

We'll need to look at your DSA setup first...

Right, let's get into the DSA problem. Seeing no impressions after a week feels like a lifetime in paid ads, but for a new DSA campaign on a massive, complex site, it's not entirely unheard of. DSA works by Google crawling your site (or a specific page feed you provide) and then matching queries to the content on your pages. In healthcare, this process gets a whole lot more scrutinised and, frankly, slower.

The first thing to understand is that you're asking Google's bots to read thousands of pages, understand the context of complex medical terms, and then decide which of those pages are 'safe' to advertise without a human manually signing off on each one. It's a massive ask, and the system is designed to be cautious. A week might just not be enough time for the crawler to do its job, index the content for advertising purposes, and for the bidding algorithm to find its feet. I remember one client in the recruitment space whose DSA campaign took nearly two weeks to properly start delivering impressions. It's a ballache, but patience is part of it.

However, "wait and see" is rubbish advice on its own. There are definately some things you can check and tweak to give it a kick up the backside. It's usually not one single thing, but a combination of factors that causes a DSA campaign to stall at the starting line.

I'd start by looking at how you've defined your targets. Have you pointed it at your entire website, or are you using rules or a page feed? For a site with thousands of pages, telling it to target "all webpages" can sometimes be too broad, ironically. Google might struggle to find a coherent theme. A better approach is often to create dynamic ad targets based on categories, URL strings, or page content. For example, create one target for all URLs containing "/diagnosis/", another for "/tests/", and so on. This gives the algorithm a more focused area to work with and helps you write more relevant ad descriptions for each target.

You also need to be ruthless with your negative keywords, but not *too* ruthless. Have you added any broad match negatives that could be accidentally blocking legitimate terms? For instance, if you've added "free" as a negative, it could be blocking searches like "symptoms of gluten-free intolerance". It's a delicate balance. The other side of this is the auto-targeting itself. Make sure your dynamic ad targets aren't so narrow that nothing matches. I once saw an account where the target was set to `URL contains "specific-test-name"` and `Page content contains "exact-phrase-here"`. The combination was so specific it matched zero pages on the entire site.

To help you work through this, I've put together a little flowchart of the process I'd typically follow when a DSA campaign isn't firing. Work through it step-by-step.

I'd say you need to get compliant...

Now, let's talk about the big one: the "Eligible (Limited)" status. This is 100% a policy issue, and it's the main reason your DSA campaign is probably struggling too. Even if the DSA campaign was technically set up perfectly, if the pages it wants to send traffic to are flagged for policy violations, the ads simply won't run. You can't outsmart this with campaign settings.

Here’s the brutally honest truth: Google's healthcare policies are a nightmare to navigate. They are deliberately broad and interpreted by automated systems that scan your ad copy and, crucially, your landing pages for trigger words. Submitting appeal after appeal without changing anything on your site is like banging your head against a brick wall. The bot will just scan the page again, see the same trigger words, and deny the appeal. You have to fix the root cause.

The policy you're likely falling foul of is 'Personalized advertising' regarding health. Google prohibits advertisers from implying they know a user's personal health information or targeting users based on sensitive health conditions. This means language is absolutly everything. Words like "you," "your," or any direct address combined with a specific condition are often immediate red flags. For example, an ad saying "Struggling with fertility? We can help" is almost guaranteed to be limited. A landing page with the headline "Your Guide to Managing Diabetes" will also get flagged.

You need to systematically go through your key landing pages and perform a "content detox." Remove any language that promises results, uses overly sensational terms, or directly addresses the reader about a specific, sensitive condition. Your entire tone needs to shift from direct response marketing ("Solve your problem now!") to neutral, clinical information ("Learn about available diagnostic options.").

Here's a table to give you a clearer idea of the kind of language shifts you need to make. This isn't exhaustive, but it illustrates the principle.

Another massive factor is certification. For many areas of healthcare advertising, Google requires you to be certified through third-party organisations like LegitScript. If you're advertising anything that could be considered a pharmaceutical service or addiction treatment, this is non-negotiable. It's a proper process that involves them vetting your business, but once you have it, it's like a green tick for Google's systems and can get ads approved that would otherwise be stuck in "limited" forever. You need to investigate if any of your services fall into categories that require this. It's an investment, but probably cheaper than wasting ad spend on campaigns that don't run.

You probably should restructure your campaigns...

So, once you've cleaned up your landing pages and ad copy, you need a campaign structure that's built for scale but also for control. Relying solely on a single, massive DSA campaign for a website of your size is a recipe for disaster. You get no real control over which terms trigger which pages, and your ad copy is generic by definition.

I would propose a hybrid structure. Think of your services in broad themes or categories, for example: 'Diagnostic Imaging', 'Blood Tests', 'Women's Health Services', 'Preventative Care', etc. Each of these themes should be its own campaign.

Within each campaign, you'd have two types of Ad Groups:

1. Standard Ad Groups: These target your core, high-volume keywords manually. For the 'Blood Tests' campaign, you'd have ad groups for terms like "private blood tests near me", "full health check blood test", "thyroid function test", etc. This is where you have maximum control. You write specific, highly relevant ads for these exact terms and send them to the most relevant page. This should be the bulk of your budget.
2. A DSA Ad Group: This is where DSA comes back in. Within the 'Blood Tests' campaign, you'd have one DSA ad group. But instead of targeting the whole site, you'd set its dynamic ad target to only include pages within your blood test category (e.g., `URL contains "/blood-tests/"`). Its job is to act as a safety net, catching all the long-tail, unpredictable search queries you'd never think of, like "cost of vitamin d deficiency test london" or "what blood test shows inflammation markers uk".

This structure gives you the best of both worlds. You maintain tight control and relevance on your most important keywords, while using DSA strategically to capture valuable long-tail traffic without needing to manage thousands of keywords manually. You also need to add all the keywords from your standard ad groups as exact match negatives to your DSA ad group to prevent them from competing with each other. This is a critical step many people miss.

Here's a visual representation of how that structure might look for just one part of your business.

You'll need to manage your cost expectations...

One final thing to consider is cost. Healthcare is one of the most expensive and competitive verticals on Google Ads. People are searching with high intent for solutions to significant problems, and businesses are willing to pay a premium to reach them. You mentioned running into challenges, but I wonder if cost per lead is one of them, or if you've even gotten that far yet.

Based on my experience, CPLs can vary wildly. For a local service like an HVAC company, we've seen CPLs around $60. For childcare signups, it was closer to $10. Healthcare is likely to be at the higher end of that spectrum, especially for specialised diagnostic tests. You could easily be looking at £50-£150 per qualified lead (a form submission or phone call) depending on the specific service and your location. The CPCs alone can be eye-watering, often in the £5-£15 range for competitive terms.

This is why getting the compliance and structure right is so important. If you're paying that much per click, you can't afford to send them to a page that doesn't convert or have your ads constantly disapproved. Every bit of wastage is magnified. To help you get a feel for the potential numbers, I've built a simple calculator below. You can adjust the sliders for monthly ad spend, your estimated average CPC (be realistic!), and your website's conversion rate (the percentage of clicks that become a lead). It'll show you the kind of volume you might expect. A typical conversion rate for a lead-gen site is around 2-5%, but for healthcare, it might be lower initially until you really nail the messaging.

This is the main advice I have for you:

To wrap things up, you're not facing an impossible task, but you do need a more strategic approach than you're currently using. Just setting up a DSA campaign and hoping for the best in a sector like healthcare is asking for trouble. Here are the main recommendations I've detailed, all in one place.

This is a lot to take in, I know. Navigating Google's policies in healthcare while trying to build a scalable advertising engine is genuinely one of the toughest challenges in paid media. It requires a deep understanding of the rules, a meticulous approach to content, and a strategic view of account structure. It’s not just about knowing how to use the Google Ads platform; it's about knowing how to use it within a very restrictive set of externally imposed rules.

This is often where bringing in an expert can make a huge difference. An experienced agency or consultant has already made the painful mistakes and learned these lessons on other accounts. We can spot policy violations on a landing page in minutes that might take you weeks of frustrating appeals to figure out. We know how to structure accounts for this specific challenge and can often get campaigns live and performing much quicker.

If you'd like to go through your account and website together in more detail, we offer a completely free, no-obligation initial consultation. We could spend 20-30 minutes on a call, share screens, and I could give you some more specific, actionable feedback on your exact setup. It often helps to have a second pair of expert eyes on it.

Let me know if that's something you'd be interested in.

Regards,

Team @ Lukas Holschuh