Table 2. Themes and Examples of Claims Made by Companies Marketing and Selling Discounted Imaging Services via Groupon Vouchers, and Related Customer-Patient Reviews.

Topic	Company advertisement (n = 84)	Consumer review (n = 2044)
Consultation	Consultation required, n = 57 (67.9%) “Consultation required, noncandidates will be refunded.” (MRI)	Consumer deemed a noncandidate after preimaging consultation, n = 2 (0.1%) “After I went there, they told me I had to go and see doctors which they would not cover.”
		Consumer noted helpfulness of consultation, n = 4 (0.2%) “The consultation was very thorough, but it took much longer than they had told me. I was in the office a total of one hour and 45 minutes. The scan took less than 10 minutes. I appreciate all the great information given to me, but I did not budget that much time.”
		Consumer noted unhelpfulness of consultation, n = 4 (0.2%) “The scan was awesome, but my husband didn't like the way they try to scare you into buying a full body scan and then as if that wasn't enough they try to get you to buy these huge packages. I would have gone for it, but he didn't like that. So, the hour consultation is nothing but trying to get you to buy more!”
Medical claims	Made unsubstantiated medical claims, n = 38 (45.2%) “Both safe and fast…the automated diagnostic equipment does not employ harmful radiation or uncomfortable breast compression. It can also see through dense breast tissue, resulting in a 90% cancer-detection sensitivity compared to 38% with mammography. And with no known side effects, the technology helps women of all ages walk out of the clinic free of pain and stress…” (breast thermography)	Consumer claimed imaging service was accurate, n = 9 (0.4%) “…[I]t turned out to be 100% accurate.”
	Claimed service can help prevent disease, n = 8 (9.5%) “[A] CT heart scan shows even the smallest coronary calcification in the heart, helping to prevent heart disease...[and] predict future heart attacks.” (CT)	Consumer claimed imaging service was inaccurate, n = 5 (0.2%) “We had a great experience with our son in 2017, but I bought the Groupon with this pregnancy and was told the wrong gender. We found out the correct one at my actual OB appt a month later. Really thankful we didn’t have a gender reveal party planned this time.”
	Claimed service can help estimate risk of developing disease, n = 8 (9.5%) “Noninvasive screening designed to determine a person's risk for developing breast cancer.” (breast thermography)
Risks	Risks of services outlined in Groupon voucher description, n = 1 (1.2%) “While it scans bodies, it exposes patients to the same minimal radiation as a mammogram.” (CT)	NA
Upselling	NA	The company tried to sell additional products/services to the consumer, n = 90 (4.4%) “Don't spend your time and money, after an hour talking about what you need to take care of your health, they want to sell you a scan of the whole body for almost 5000 dollars.”
		The seller did not try to sell consumer more products/services, n = 13 (0.6%) “Does not pressure you into buying other tests or services.”
Motivations	NA	Consumer was self-motivated to purchase imaging service, n = 25 (1.2%) “I got this for ‘maintenance’ for my husband and myself. My husband found he had a ’widow maker’ in his heart. He has now had triple bypass surgery and is doing terrific!! We are so blessed to have had this procedure done. It saved his life. Thank you.”
		Consumer pursued additional testing/scans/interventions or indicated willingness to return for additional visits, n = 341 (16.7%) “I have this Groupon to thank for not having a heart attack and maybe my life. I need 3 stents set for the end of this month. Best $$ I ever spent.”

Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging; NA, not applicable.