Why telehealth companies are reconsidering Stripe

Many telehealth and wellness organizations are reconsidering their relationships due to issues around payment processing, category codes, and restricted business classifications. Before choosing your subscription billing providers, it’s important to know what’s on the table. 

Key highlights:

• Restricted status is continuous: Stripe classifies telehealth as a restricted industry, meaning approval isn't a one-time gate. It can be modified or revoked at any time.

• Risk follows the merchant category: Some prescription-related telehealth models may be assigned MCC 5122 or 5912, depending on their business model and acquiring relationship, which carry card-network-level risk regardless of which processor you use.

• Single-processor architecture creates single points of failure: Tying your payment vault, retry engine, and subscription logic to one account creates significant operational exposure. if compliance policies shift.

• Decoupling reduces processor concentration risk: Using Recurly as an independent subscription and payment orchestration layer lets you store tokens securely, route across multiple gateways, and protect processing continuity.

Does Stripe support telehealth billing?

Yes, but approval is ongoing.

Stripe's own Prohibited and Restricted Businesses page lists the following under Restricted Businesses, specifically under the regulated industries section meaning they require additional due diligence and ongoing review:

• Online pharmacies, including SaaS platforms

• Card-not-present prescription-only products and pharmaceuticals

• Prescription-only and regulated medical devices

• Prescription delivery services

• Telemedicine and telehealth services

Stripe explicitly states that approval “... may be modified or revoked by Stripe at any time." This means payment collection could be disrupted if your approval or account status changes, which can happen in high risk and compliance specific industries such as telehealth.

Why does prescribing telehealth get classified as high-risk?

It's not about how your business is run. It's about what you sell and how the card networks code it.

Prescription-related telehealth businesses may be assigned MCC 5122 or 5912 when their underlying business activity involves wholesale drug distribution or retail pharmacy sales. Visa classifies card-absent transactions under these MCCs as high-integrity-risk. Exact classification depends on the operator’s business model, primary line of business, and acquiring relationship.

This is a card-network classification, which means it travels with you. Move from Stripe to any other processor, and the same MCC codes, the same card-not-present risk profile, and the same regulatory scrutiny still apply. Not every telehealth business will run into friction because of it, but every business in this category carries the exposure, regardless of who processes the transaction.

So what actually changes if you leave Stripe?

If network risk follows your category everywhere, what actually changes when you adjust your billing stack?

The difference lies in decoupling your subscription infrastructure from a single processor. When your customer payment tokens, routing, and subscription logic are locked inside one processor account, an account-level review or freeze can halt payment collection.

• Secure card storage & data portability: Depending on how payment details are stored and tokenized, Recurly can support gateway failover and coordinated migrations across supported providers. Gateway-specific tokens are not inherently portable, and migrations may require cooperation from both processors.

• Custom gateway routing: Use your own business logic to select among configured gateways, then pass the appropriate gateway code through Recurly’s API. This gives operators the flexibility to distribute transaction volume across specialized or secondary merchant accounts.

• Gateway failover & intelligent retries: During a detected gateway outage, Recurly can route eligible transactions to a configured backup gateway. Separately, Intelligent Retries uses machine learning to optimize when eligible soft declines are retried on the same payment method.

What should you evaluate in a telehealth billing platform?

Three questions worth asking any platform before you sign, based on where telehealth operators actually run into friction:

1. How does the platform handle payment data portability across gateways?
   
   Ensure card data is secured in an independent vault so you maintain operational flexibility if your gateway relationships change.

2. Can transaction traffic be routed using specific business logic?
   
   Verify that you can route transactions based on region, currency, card BIN, or address parameters to optimize approval rates across merchant accounts.

3. How does the system protect against processor downtime and soft declines?
   
   Look for automated gateway failover during primary gateway communication outages, paired with ML-driven retry timing to recover declined recurring payments.

None of this is about switching to a "better" processor for its own sake. It's about whether your billing infrastructure can absorb what baggage telehealth already carries, instead of fighting it account by account.

Ready to see what a subscription platform built for regulated health actually looks like? 

Explore Recurly's telehealth billing platform

Disclaimer: This article is provided for general informational purposes only and does not constitute legal, privacy, security, or compliance advice. Requirements — including those related to HIPAA, subscription billing, and cancellation practices — vary by jurisdiction and business circumstances and may change over time. Consult qualified legal and compliance professionals to evaluate your organization’s specific obligations. Examples are illustrative and do not guarantee particular outcomes.