The short answer
There are two ways a telehealth platform can touch your patients' money. Either the cards are charged on a merchant account in your name and the platform runs billing logic on it, or the cards are charged on the platform's account and you are paid what is left after its fees. Fees can sit on top of either.
As of November 4, 2026, Rimo, Karpa and Cuvo say on their own pages that the brand is the merchant of record. Healthie pays practices into their own bank account through its Stripe integration at 2.9% plus 30 cents. Fuse charges a 2% or 3% merchant service fee on top of processing. CareValidate charges 3.7% all-in. And one OpenLoop services agreement, filed publicly with the SEC this year, routes patient payments through OpenLoop's Stripe account. Ownership in general (patients, records, pharmacy, brand) is covered in who owns what on a white-label platform; this post stays on the money.
Nine payment models, side by side
| Platform | Whose account charges the card | Fee on payments | Source, checked Nov 4, 2026 |
|---|---|---|---|
| Fuse Health | Not stated on the pricing page | 3% (DIY) or 2% (Growth, Partner) "charged on the total of each patient payment"; processing "may apply separately" | fusehealth.com/pricing |
| CareValidate | Not stated | 3.7% all-in, covering processing, fraud protection, chargeback support and HSA/FSA acceptance | carevalidate.com |
| Healthie | Healthie's Stripe integration, no separate Stripe login; funds go to your linked bank account | 2.9% + $0.30; payouts in 3 to 5 business days; Healthie no longer covers processing fees on refunds | Healthie help center |
| Rimo | Yours: "You are the merchant of record" | Card processing billed separately; tokens "live in your own Stripe account or your NMI gateway" | rimo.co |
| Karpa Health | Yours: partners "are the merchant of record" | Refunds and billing run "through their own Stripe account" | karpahealth.com |
| Cuvo | Yours: payments "settle directly to the brand's merchant account" | "No added fees on your checkout"; standard card processing | cuvo.co/pricing |
| Telegra | "Own Your Processing Account" listed on both plans | No rate published | telegramd.com/pricing |
| OpenLoop (one filed agreement) | OpenLoop's Stripe account | Fixed fee per transaction plus a merchant processing percentage, both redacted | SEC exhibit |
| Stripe, direct | Yours | 2.9% + 30 cents per domestic card charge; $15 per dispute, plus $15 if you counter it | stripe.com/pricing |
Remedora's $200 fee covers "payments" without saying whose account or what rate, so it is not in the table. Ask.
A percentage fee also taxes your medication
Fuse's wording is precise: the fee is "charged on the total of each patient payment." On a $300 monthly charge where $150 is medication you pass through at cost, a 2% fee is $6, and $3 of it is a fee on the pharmacy's money. A per-consult or flat fee does not grow when medication prices rise. A percentage fee does, and with branded GLP-1 cash prices at $299 to $449 a month, that matters.
The volume math is in the year-one cost model: at 1,000 active patients paying $300 a month, 2% is $72,000 a year and 3% is $108,000, before processing. CareValidate's 3.7% includes processing, so compare it against processing plus fee, not against fee alone. At Stripe's published rate the same volume costs about $108,000 to process, which makes CareValidate's 3.7% ($133,200) about $25,200 more than processing alone, and cheaper than processing plus Fuse's 2% ($180,000).
We are not against percentage fees. For a brand with $40,000 a month in volume, Fuse DIY's 3% is $1,200, and the alternative may be a five-figure setup fee. The fee gets expensive slowly, so negotiate the step-down before you need it.
What the OpenLoop agreement shows, and why it is a good model to ask for
OpenLoop does not publish pricing, but one of its services agreements is public. A Telehealth Services Agreement between OpenLoop Healthcare Partners, PC and Enhanced US LLC, effective October 1, 2025, was filed this year as an exhibit to the S-4/A for Enhanced Group's SPAC merger. Dollar amounts and percentages are redacted. The structure is not.
The payment flow in Schedule D reads: "Payment is processed on OpenLoop's Stripe account." Schedule F says OpenLoop receives "a fixed, all-inclusive fee" per transaction, plus compensation "for merchant processing" as a percentage. The brand sets the retail price and receives the remainder.
Section 10(ii) is the clause worth copying into every contract you sign, whoever holds the account. On termination OpenLoop will act "without delay" to transfer patient information to another EMR system and handle "the movement of patient credit card tokens to such other merchant account" as the partner directs, subject to data protection laws.
That is one agreement with one partner, and terms elsewhere may differ. It is still more than most vendors put in writing about tokens.
How tokens actually move
A stored card on Stripe is a token tied to the Stripe account that saved it. Moving it means a processor-to-processor transfer of the underlying card data, and the rules are strict. Per Stripe's payment data export docs, Stripe sends card data only to another PCI DSS Level 1 processor, asks for that processor's Attestation of Compliance, delivers an encrypted file, and excludes cards saved through Link.
Two practical consequences. If the account is yours, you can request the export yourself. If the account is the platform's, only the platform can, so the contract has to oblige it. Without that, patients re-enter cards after a migration, and some do not; the migration playbook covers the patient side.
Payouts, reserves and the dispute ratio
When the platform holds the account, your cash arrives on its remittance schedule. In the filed OpenLoop agreement the timing is redacted. Healthie publishes 3 to 5 business days on your own account. Ask for the number of days, in writing.
Reserves follow the merchant. In a restricted category (Stripe lists telemedicine and card-not-present prescription products as needing approval) a processor can hold back part of each day's volume. If the reserve is on the platform's account, find out whether yours is pooled with other brands and when it is released after you leave.
The same goes for disputes. Since April 1, 2026, Visa's VAMP threshold is 1.5% of settled card-not-present transactions, with an $8 fee per disputed or fraudulent transaction above it; the VAMP post has the mechanics. On a shared platform account, the ratio belongs to the account. On your own, it is yours, and so is the history a future acquirer or processor will ask for.
Holding your own account is harder at the start: you go through underwriting yourself, which passing processor review walks through. We still think it is the right default for any brand that plans to be around in three years.
Five questions to settle before you sign
- Whose merchant ID is on the card statement, and whose bank account receives settlement?
- Every fee on payment volume: percentage, per transaction, refunds, disputes, and whether it applies to medication dollars.
- Payout timing and any reserve: how much, how long, pooled or separate.
- Who answers disputes and refunds, and who pays the dispute fees.
- On exit: will the vendor move card tokens to a PCI Level 1 processor you name, within how many days, at what cost, and what happens to disputes that arrive after you leave?
Where Turbopills stands
Turbopills runs billing on your own gateway accounts, so you are the merchant of record and the tokens, reserves and dispute history stay with you. Subscriptions start only when a clinician approves the visit, failed charges retry automatically, refunds take one click, and the billing engine supports more than one gateway with failover. We do not publish pricing yet (private beta, quoted per program), so ask us questions 2 and 5 in the demo and get the answers in writing. If you would rather not underwrite a merchant account yourself at all, a platform that holds it for you is a fair trade, and we will say so.
FAQ
What is a merchant of record on a telehealth platform? The business whose merchant account charges the patient's card and whose name appears on the statement. If it is the platform, your revenue passes through its account before reaching you. If it is you, the platform runs billing on your gateway and payouts go straight to your bank.
How much do telehealth platforms charge for payment processing? On pages checked November 4, 2026: Fuse adds 2% or 3% on each patient payment with processing separate, CareValidate charges 3.7% all-in, and Healthie passes through 2.9% plus 30 cents. Rimo, Karpa and Cuvo have you process on your own account at your processor's rate.
Can I take my patients' saved cards if I leave a platform? Only through a processor-to-processor transfer. Stripe exports card data only to another PCI DSS Level 1 processor and excludes cards saved with Link. If the cards sit on the platform's account, your contract must require it to make the transfer.
Does a telehealth platform's dispute ratio affect my brand? Yes, if you share its merchant account. Visa's VAMP threshold of 1.5% applies to the account, so other brands' disputes count toward the same ratio. On your own account, only your disputes count.