Payments · Telehealth6 min readUpdated November 2, 2026

International Payments for Telehealth Companies

What limits a telehealth brand abroad: where the patient is, processor rules by country, ad rules by country, and what foreign cards cost and decline.

Nick Bonnassies, CMO at Tagada · checked against 12 sources

Article summary

TL;DR

For a telehealth brand, the limit abroad isn't the card. It's where the patient is: the clinician must be allowed to treat there, and processors and ad platforms set their own country lists. Stripe prohibits telemedicine in Mexico, Meta allows prescription-drug targeting only in the US, Canada and New Zealand. Foreign cards then cost more and decline more.

US medical boards generally treat care as happening where the patient is; the IMLC covers 44 states, the District of Columbia and Guam.
Stripe lists "Telemedicine" among activities prohibited in Mexico, and restricts it elsewhere (read November 2, 2026).
Meta: "Only target people in eligible countries (United States, Canada or New Zealand)" for prescription drug ads.
TikTok bans remote-diagnosis medical services ads in Austria and online consultation ads in Romania.
One 2026 acquirer schedule adds 0.678% to a Visa cross-border sale in the merchant's currency, 1.13% in another.

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On this page

This guide is part of our hub on telehealth payment processing. The general guide, for any business: international and multi-currency payment processing.

Three locations that matter

A retail store asks where the card comes from. A telehealth brand has to ask three questions, and they can each give a different answer.

Location	What it decides	Where you see it
Where the patient is	Whether a clinician may treat them2	Address, intake, IP at the visit
Where the card was issued	Cross-border fees, approval odds9 10	Card BIN
Where you, the merchant, are	Which acquirer can process your sales5	Your entity and outlet

A US resident on vacation with a US card can still be outside your clinicians' reach. A foreign resident living in a state you cover can pay with a foreign card. Check the first location before the payment, not after.

Fig. 1Patient, card, merchant: three answers that can differ

US resident on vacation, US cardCan be outside your clinicians' reachCheck the patient's location before the payment
Foreign resident in a state you cover, foreign cardCan be treated and can pay; cross-border fees applyCharge in US dollars
Patient located in a place you don't coverNo clinician may treat themBlock the sign-up with a clear message, before the card step

The patient's location comes first, before any payment question.

AMA issue brief on telehealth licensure, May 8, 2023; Visa Core Rules, April 18, 2026.

The clinical license comes first

US medical boards generally treat a telehealth visit as happening where the patient is located, so the clinician needs authority there, as the AMA summarizes state rules2.

Inside the US, the Interstate Medical Licensure Compact offers "a voluntary, expedited pathway to licensure" across 44 states, the District of Columbia and Guam1. It isn't a national license, and it stops at the border.

Outside the US, each country sets its own rules for remote consultation and prescribing. Treat every new country as a new license question for counsel, before any payment question. US state rules in detail: telehealth across state lines.

Processors by country

Processor support for telemedicine varies by country, and so does the line between a consultation and a medication.

Stripe, Mexico
"Telemedicine" appears in the list of activities prohibited in Mexico3.
Stripe, elsewhere
Telemedicine is restricted, with approval "specific to each service offer"3.
Stripe, pharmacies
"Pharmacies will only be approved for merchants in the US, Canada, the EU, Australia, the UK, and Japan," per its FAQ4. If your brand also sells the medication, that list applies to that side.
Local acquiring
Visa's rules say an acquirer "must accept Transactions only from a Merchant Outlet within the Acquirer's Country of Domicile", unless Visa approves otherwise5. A local entity needs a real local outlet, not just a local address.

Who sells the medication and how it's billed: consultation vs medication payments. The pharmacy side abroad: online pharmacy payment processing.

Ads by country

Even where you can treat and get paid, you may not be able to advertise.

Platform	Telemedicine rule by country
Google Ads	Telemedicine "allowed with limitations" in Australia, Canada, France, Indonesia, Japan, New Zealand, the Philippines, Singapore, South Africa, Spain, Sweden, the UK and the US; certification required6
Meta	Prescription drug ads target only the US, Canada or New Zealand, people 18 and over; LegitScript then Meta authorization7
TikTok	Prohibits ads for "Medical services provided online or through apps that include remote diagnosis and remote treatment" in Austria and "Online services or apps for GP or medical consultation services" in Romania8

Country rules change: check each platform's page before a launch. The full ad picture: can you advertise telehealth on Facebook, Google and TikTok.

Foreign cards: cost and declines

Patients paying with cards from abroad cost you more and get declined more often.

Cross-border fees: in TD Merchant Solutions' July 2026 schedule, a Visa cross-border sale adds 0.678% when settled in the merchant's currency and 1.13% in another currency9. Your processor's numbers will differ.
Approvals: issuers are more cautious with foreign merchants, and cross-border payments decline more, as Adyen explains10.
Currency: charge in US dollars if you only treat US patients; a foreign-currency price helps only where you're licensed to treat.

Fig. 2What a Visa cross-border sale adds, in one acquirer's schedule

Settled in the merchant's currency0.678%
Settled in another currency1.13%

Source: TD Merchant Solutions, July 2026

Your processor's numbers will differ.

TD Merchant Solutions, Fee Descriptions, July 2026.

More on declines and how to read them: reducing payment declines for telehealth companies.

Before you open a country

License: confirm with counsel that your clinicians can treat patients located there, and on what conditions.
Medication: check who can dispense and ship there; that's a pharmacy question, not yours alone.
Processor: ask whether telemedicine is supported in that country and under which entity3 5.
Ads: check Google, Meta and TikTok rules for that country6 7 8.
Checkout: block sign-ups from places you don't cover, with a clear message, before the card step.
Data: check local health-data rules before collecting intake answers.

License first, payment last: the card step is the end of the list, not the start.

How to block by location at checkout: telehealth across state lines. Ad tracking across markets: Meta and TikTok ads for telehealth companies.

How Tagada helps

Routing, 3DS2 and a portable vault

TagadaPay brings "Native 3DS2, device intelligence, and rules engine: approve real customers, block the rest"12, with "Enhanced review for regulated verticals."

Routing across TagadaPay and processors such as Stripe, NMI and Airwallex, with one logic and a cascade to another processor when one is down or times out
Your vault, portable: "Switch processors without re-onboarding customers"
Support: "24/7 human support on Slack Connect"

Tagada follows Visa and Mastercard rules and the laws that apply to payments.

Building a telehealth brand from scratch? Tagada Rx runs storefront, doctors, pharmacy and payments in one stack, with clinicians "Licensed in the patient's state" and a licensed US pharmacy11. Its scope is explicit: "US patients only", by selection11.

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Updated on November 2, 2026

Nick Bonnassies

CMO at Tagada

CMO at Tagada. Before Tagada, Nick built direct-to-consumer brands that generated over $115M in sales, raised over $25M in crowdfunding and sold two of them. He also works as a fractional CMO on marketing operations and AI systems.

Frequently asked questions

Can a US telehealth company treat patients in other countries?

Only where its clinicians are allowed to practice. US boards generally look at where the patient is, and each country sets its own rules for remote care and prescribing. Treat every country as a separate license question for counsel, then check processor and ad rules there.

Can I accept foreign cards on a telehealth checkout?

Yes, if the patient is somewhere you can treat. Foreign cards cost more, with cross-border fees such as 0.678% to 1.13% in one 2026 schedule, and decline more often. The card's country doesn't tell you where the patient is.

Does Stripe support telehealth outside the US?

Telemedicine is restricted at Stripe and needs approval for each service offer. It's prohibited in Mexico. For pharmacies, Stripe's FAQ lists only the US, Canada, the EU, Australia, the UK and Japan. Ask before you open a market.

Where can I advertise telehealth services?

Google allows telemedicine with limitations in 13 countries, including the US, Canada and the UK, with certification. Meta limits prescription drug ad targeting to the US, Canada and New Zealand. TikTok bans remote consultation ads in Austria and Romania.

Sources

Checked November 2, 2026

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