Healthcare Payment Solutions UK: Merchant Accounts, Card Payments & Practice Integrations

Healthcare Payments: The Quick Answer

Healthcare businesses rarely have one simple payment journey.

A patient or client might pay at reception after an appointment, leave a deposit when booking, receive a payment link for an outstanding balance, pay for higher-value treatment in stages or make recurring payments for an ongoing plan.

Different healthcare sectors also create very different payment requirements. A veterinary practice may need to collect an unexpected emergency bill. An optician may have hundreds of recurring contact-lens subscribers. A dental practice may take deposits and higher-value payments for implants or orthodontics. An NHS GP surgery may only need to collect permitted fees for non-NHS reports and services.

The right healthcare payment solution therefore depends on much more than the advertised card-processing rate.

Healthcare businesses should consider:

• the type of healthcare business;
• how patients or customers pay;
• average and maximum transaction values;
• face-to-face versus remote payments;
• practice-management software;
• booking-system integrations;
• deposits and advance payments;
• recurring payments;
• insurance-related payments;
• settlement;
• reconciliation;
• multi-site requirements;
• PCI DSS;
• provider underwriting; and
• what happens if the payment provider later needs to be changed.

This guide provides an overview of healthcare payments in the UK and links to our detailed guides for individual healthcare sectors.

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Which Healthcare Payments Guide Do You Need?

Healthcare is not one payment category. Start with the type of organisation you operate.

What Does a Healthcare Payment Setup Usually Include?

There is no single product called a healthcare merchant account that fits every practice.

The final setup may combine several payment services.

Merchant account or payment service provider

The acquiring or PSP arrangement enables the healthcare business to accept eligible card payments and receive settlement.

Card machines

Card terminals remain important for payments made at reception, at an optical retail counter, within a veterinary practice or elsewhere on the premises.

Payment gateway

A payment gateway may be required where payments are collected online through a website, booking system, patient portal or other digital application.

Payment links

Payment links allow a practice to send a customer a secure online payment request without building a conventional ecommerce checkout.

Read our Pay by Link for Merchants guide.

Virtual terminal and MOTO

Practices taking eligible card payments over the telephone may require an approved virtual-terminal or MOTO arrangement.

See our MOTO Merchant Accounts guide.

Recurring payments

Healthcare memberships, optical contact-lens plans, veterinary health plans and other subscription models may require recurring collection.

Read our Subscription Payment Processing guide.

Integrated payments

Payment functionality may also connect directly with clinical, practice-management, booking or billing software.

Our Integrated Payments Solutions UK guide explains how payments can connect with wider business software.

Private Healthcare Payments

Private healthcare businesses can have several payment flows operating at the same time.

A clinic may receive:

• self-pay patient payments;
• private medical insurance income;
• patient excesses;
• appointment deposits;
• consultation fees;
• diagnostic payments;
• treatment balances;
• payment links;
• telephone payments;
• recurring payments;
• remote-consultation fees; and
• payments across multiple clinic locations.

This makes payment processing part of the wider patient billing and practice-management environment.

For the detailed sector guide, see Private Healthcare Merchant Accounts & Payment Solutions for Doctors and Clinics.

NHS GP Practice Payments

NHS GP practices have a different payment requirement from private clinics.

The purpose of the payment setup is not to charge patients for ordinary NHS-funded treatment. Instead, practices may need an efficient way to collect payment for permitted non-NHS work such as certain reports, certificates, forms and other chargeable services.

A practice may use:

• a card terminal at reception;
• a payment link;
• an approved telephone-payment facility;
• invoices for insurers, employers or other third parties; or
• a combination of these methods.

Our dedicated Card Payments for NHS GP Practices guide explains the distinction between NHS-funded and potentially chargeable work.

Dental Practice Payments

Dental practices can combine relatively small routine payments with substantially larger private-treatment transactions.

Payment requirements may include:

• NHS patient charges;
• private treatment;
• mixed NHS/private treatment;
• appointment deposits;
• payment links;
• implants;
• orthodontics;
• clear aligners;
• cosmetic dentistry;
• staged treatment payments;
• patient finance;
• dental plans;
• integrated card terminals; and
• multi-practice reporting.

The dental practice-management system can also influence which payment functions and providers are available.

Read our full Merchant Accounts for Dentists guide.

Veterinary Payments

Veterinary payments are distinctive because substantial treatment costs can arise unexpectedly.

A pet owner may need to pay for:

• emergency treatment;
• surgery;
• hospitalisation;
• diagnostics;
• a treatment deposit;
• an insurance excess;
• uninsured treatment;
• a specialist referral;
• an outstanding balance; or
• a recurring pet health plan.

Payments may also need to be reconciled against pet-insurance claims and specialist veterinary practice-management systems.

Read our dedicated Merchant Accounts for Vets guide.

Optician and Optical Retail Payments

Opticians combine healthcare and retail within the same customer journey.

A customer might:

1. attend an eye examination;
2. use an NHS optical voucher;
3. select frames;
4. choose prescription lenses and upgrades;
5. pay a deposit;
6. return when the glasses are ready;
7. pay the outstanding balance; and
8. later join a recurring contact-lens plan.

Recurring payments are particularly important within optical businesses because contact-lens subscriptions can produce a substantial long-term payment book.

Read our Merchant Accounts for Opticians guide.

Aesthetics Clinic Payments

Aesthetics clinics can combine appointments, deposits, treatment packages, retail products, online bookings and higher-value payments.

The payment provider may also need to understand:

• treatments offered;
• products sold;
• average and maximum transaction values;
• online versus face-to-face activity;
• future appointments;
• treatment packages;
• stored cards;
• recurring memberships;
• refunds;
• chargebacks;
• booking software; and
• previous processing history.

Some clinic-management platforms can also restrict which payment providers integrate directly with the software.

See our Aesthetics Clinic Payment Solutions guide.

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Healthcare Software Can Determine Which Payment Providers You Can Use

Practice-management and booking software increasingly influence payment-provider choice.

Healthcare payment functionality can sit directly inside:

• clinic-management systems;
• dental PMS platforms;
• veterinary software;
• optical practice systems;
• booking platforms;
• patient portals;
• billing systems;
• subscription platforms; and
• healthcare SaaS products.

This can make payments substantially easier to administer, but it can also create dependency on a particular PSP, gateway or terminal provider.

Integrated Payments in Healthcare

An integrated-payment journey can connect the payment directly with the relevant invoice or appointment.

For example:

invoice → select payment → amount sent to terminal → patient pays → invoice automatically updated

rather than:

invoice → amount manually entered into terminal → patient pays → staff manually record transaction again.

Integration can help reduce:

• double keying;
• incorrect transaction values;
• unrecorded deposits;
• payments allocated to the wrong account;
• manual reconciliation; and
• administrative workload.

Read our Integrated Payments Solutions UK guide.

Healthcare Software Providers Have a Different Payments Opportunity

For healthcare technology businesses, payments may become part of the software proposition itself.

An established dental, veterinary, optical or clinic software business with hundreds or thousands of healthcare customers may potentially consider:

• integrated payments;
• embedded payments;
• merchant onboarding;
• terminal integration;
• payment links;
• recurring billing;
• white-label payments;
• payment revenue share;
• payment monetisation; and
• managed PayFac models.

This is a different requirement from a healthcare practice choosing a merchant account.

Software companies should read our Payments for Healthcare Software Platforms guide.

Healthcare Booking Systems and Payments

Many healthcare payment journeys start before the patient arrives.

A booking platform may support:

• fixed deposits;
• percentage deposits;
• full payment at booking;
• stored payment credentials;
• payment links;
• cancellation charges;
• refunds;
• repeat appointments; and
• booking reconciliation.

Practices should therefore assess payment providers against the entire booking lifecycle.

Read our Payment Providers for Booking Systems guide.

Deposits in Healthcare

Deposits can occur across several healthcare sectors.

Examples include:

• private medical appointments;
• dental treatment;
• veterinary procedures;
• aesthetic treatments;
• diagnostics;
• optical orders;
• specialist consultations; and
• other appointments where time, stock or clinical resources are reserved in advance.

The practice should make clear:

• what the deposit relates to;
• how much is charged;
• when it becomes payable;
• how it is applied to the final balance;
• what happens if treatment changes;
• what happens if the appointment is cancelled; and
• when a refund may apply.

Advance payments may also be relevant during merchant-account underwriting because the provider may assess the period between the customer paying and the service being delivered.

Payment Links for Healthcare Businesses

Payment links are particularly useful in healthcare because the person paying does not always need to be physically present.

A secure payment link can potentially be used for:

• appointment deposits;
• private consultation fees;
• treatment balances;
• veterinary bills;
• insurance excesses;
• dental treatment;
• optical orders;
• medical reports;
• remote consultations;
• payments from family members; and
• outstanding invoices.

Read our Pay by Link for Merchants guide.

Telephone Payments in Healthcare

Some healthcare organisations still need to take payments over the telephone.

Where staff manually enter card information, the business may require an approved MOTO or virtual-terminal facility.

Healthcare businesses should compare:

• MOTO transaction pricing;
• fraud controls;
• staff permissions;
• PCI DSS requirements;
• refund capabilities;
• reporting; and
• whether secure payment links could replace some telephone transactions.

See our MOTO Merchant Accounts guide.

Recurring Healthcare Payments

Recurring payments are important across several parts of healthcare.

Examples can include:

• contact-lens subscriptions;
• veterinary health plans;
• dental maintenance plans;
• private healthcare memberships;
• ongoing treatment programmes;
• clinic memberships; and
• other regular healthcare plans.

Collection may use:

• Direct Debit;
• recurring card payments;
• stored payment tokens; or
• another approved recurring-payment model.

Important considerations include:

• customer authority;
• failed payments;
• retries;
• expired cards;
• cancelled Direct Debits;
• plan changes;
• refunds;
• reporting;
• practice-software integration; and
• migration if the payment provider changes.

Read our Subscription Payment Processing guide.

Stored Cards and Payment Tokens Can Complicate Switching

This matters particularly for healthcare organisations with established recurring-payment customers.

A practice should not assume stored credentials automatically move when the gateway or PSP changes.

Before switching, establish:

• who stores the existing payment token;
• whether tokens can be securely exported;
• whether the replacement provider can import them;
• where recurring schedules are stored;
• whether customers need to re-authorise payments;
• how subscriptions will continue during migration; and
• what the contractual position is regarding portability.

Read our guide to Moving Stored Cards, Tokens & Recurring Payments.

High-Value Healthcare Payments

Some healthcare businesses routinely process considerably larger transactions than an ordinary small retail merchant.

Examples include:

• dental implants;
• orthodontic treatment;
• private medical procedures;
• diagnostics;
• specialist veterinary surgery;
• premium optical purchases;
• extended treatment programmes; and
• some cosmetic procedures.

The provider should understand the genuine:

• average transaction value;
• maximum transaction value;
• monthly processing volume;
• largest expected payments;
• payment timing;
• refund profile; and
• service-delivery model.

Larger groups processing significant volumes may also want to review our High-Volume Merchant Processing guide.

Are Healthcare Businesses High Risk?

Healthcare businesses are not automatically high-risk merchants.

A conventional established optician, dental practice, veterinary business or medical clinic may be relatively straightforward for many acquiring providers.

However, providers assess the actual business model rather than the word “healthcare”.

Factors can include:

• services provided;
• products sold;
• regulatory position where relevant;
• transaction values;
• advance payments;
• future-delivery exposure;
• online sales;
• recurring payments;
• refunds;
• chargebacks;
• business history;
• ownership;
• payment channels; and
• previous processing history.

This is why two healthcare businesses that appear superficially similar can receive different underwriting decisions.

Read our Payment Provider Risk Appetite guide.

Merchant Account Underwriting for Healthcare Businesses

A payment provider may need to understand both the organisation and its actual payment model.

An application can include information about:

• legal entity;
• directors and beneficial owners;
• business activity;
• professional or regulatory status where relevant;
• website;
• monthly and annual processing volume;
• average transaction value;
• maximum transaction value;
• face-to-face versus remote activity;
• advance payments;
• recurring payments;
• refunds;
• chargebacks;
• previous processing history;
• software requirements; and
• settlement requirements.

See our detailed Merchant Account Underwriting guide.

Healthcare Data and Payment Data

Healthcare organisations can hold particularly sensitive personal information.

The payment environment should therefore avoid receiving clinical information that it does not genuinely need.

A payment processor may need information such as:

• transaction amount;
• merchant information;
• a non-clinical transaction reference;
• payment credentials;
• fraud information; and
• other information required to process and manage the transaction.

It does not normally need a detailed clinical record simply because a card transaction is taking place.

Healthcare organisations should think carefully about information placed into:

• payment references;
• gateway metadata;
• payment-link descriptions;
• transaction dashboards;
• refund notes;
• support tickets;
• card statements; and
• chargeback evidence.

PCI DSS for Healthcare Payments

Healthcare businesses accepting card payments also need to understand the PCI DSS responsibilities relevant to their payment setup.

PCI scope can differ depending on whether the business uses:

• standalone terminals;
• integrated card terminals;
• hosted online payment pages;
• payment links;
• virtual terminals;
• MOTO;
• stored payment credentials; or
• custom payment integrations.

Read our PCI DSS Compliance Guide.

PCI DSS deals with payment-card security. Healthcare privacy and data-protection obligations should be considered separately.

Payment Reconciliation in Healthcare

Processing the payment is only part of the problem.

A healthcare business may also need to understand:

• who paid;
• which appointment or invoice the payment relates to;
• which practitioner generated the revenue;
• which location received the payment;
• whether an insurer also owes part of the bill;
• whether a deposit was already collected;
• whether a balance remains outstanding;
• whether a refund was issued;
• which processor settled the transaction; and
• which payment fees were deducted.

Integrated payment systems can potentially reduce the amount of manual reconciliation required, particularly for higher-volume and multi-location organisations.

Multi-Site Healthcare Groups

Healthcare groups operating several locations may need a more sophisticated payment architecture.

A group can have:

• multiple clinics or practices;
• different legal entities;
• separate bank accounts;
• multiple merchant IDs;
• different brands;
• central finance teams;
• online and physical payment channels;
• different practice-management systems;
• recurring-payment portfolios; and
• different payment providers following acquisitions.

A group-level review should therefore consider:

• centralised pricing;
• site-level reporting;
• group reporting;
• settlement by legal entity;
• user permissions;
• refund controls;
• new-site onboarding;
• terminal estate;
• gateway infrastructure;
• software integrations; and
• payment-provider consolidation.

Settlement and Healthcare Cash Flow

Settlement determines when processed card funds reach the business bank account.

This can be commercially important where the healthcare organisation has substantial ongoing costs including:

• clinical staff;
• medicines;
• stock;
• laboratories;
• equipment;
• premises;
• specialist suppliers;
• outsourced services; and
• other operating expenses.

When comparing providers, consider both:

what does the transaction cost + when does the money arrive?

Healthcare Merchant Account Fees

A healthcare payment arrangement can include more than a single headline transaction percentage.

Costs may include:

• card-processing percentages;
• fixed transaction fees;
• terminal rental;
• gateway charges;
• authorisation fees;
• payment-link charges;
• MOTO fees;
• refund charges;
• chargeback fees;
• PCI-related charges;
• international and commercial-card costs;
• Direct Debit fees;
• software or integration costs; and
• contract termination charges.

Read our Merchant Account Fees guide.

Switching Healthcare Payment Providers

Switching a standalone card machine can be relatively straightforward.

Switching a healthcare payment infrastructure can be considerably more complex.

Before cancelling the existing provider, map:

• card terminals;
• payment gateway;
• online booking;
• practice-management software;
• payment links;
• virtual terminal;
• stored cards;
• payment tokens;
• recurring payments;
• Direct Debit;
• deposits;
• accounting integration;
• reporting;
• refund process;
• multiple sites; and
• existing contract terms.

Then identify which components depend on the current provider.

This is especially important for businesses with recurring payments or deeply integrated practice software.

What Should a Healthcare Business Compare?

What Information Should a Healthcare Business Provide When Comparing Providers?

A useful starting brief includes:

• business name and website;
• legal entity;
• healthcare sector;
• services and products provided;
• professional or regulatory status where relevant;
• number of locations;
• monthly and annual card turnover;
• number of transactions;
• average transaction value;
• maximum transaction value;
• percentage of face-to-face payments;
• percentage of online payments;
• MOTO requirements;
• payment-link requirements;
• deposit model;
• recurring-payment requirements;
• Direct Debit requirements;
• practice-management software;
• booking software;
• existing payment provider;
• current settlement time;
• merchant statements where available;
• current contract position; and
• main reason for reviewing the existing setup.

Healthcare Payments: Merchant Advice Service View

The healthcare sector demonstrates why payment-provider comparison needs to start with the business rather than a list of card-processing rates.

A GP surgery collecting occasional non-NHS fees has almost nothing in common operationally with a multi-site dental group processing high-value treatment plans.

An optician with thousands of monthly contact-lens subscribers has a different switching risk from a veterinary hospital dealing with emergency bills and pet-insurance balances.

An aesthetics clinic dependent on its booking software may have a different provider choice again.

The starting point should therefore be:

what does the healthcare business provide + when does the customer pay + how much do they pay + which software is involved + whether any payments recur + how the money is reconciled.

Once those questions are answered, the merchant account, gateway, terminals and wider payment infrastructure can be compared properly.

Healthcare Payment Guides from Merchant Advice Service

Use the following guides for more detailed information:

• Private Healthcare Merchant Accounts & Payment Solutions for Doctors and Clinics
• Card Payments for NHS GP Practices
• Aesthetics Clinic Payment Solutions
• Merchant Accounts for Dentists
• Merchant Accounts for Vets
• Merchant Accounts for Opticians
• Payments for Healthcare Software Platforms
• Integrated Payments Solutions UK
• Payment Providers for Booking Systems
• Pay by Link for Merchants
• MOTO Merchant Accounts
• Subscription Payment Processing
• Changing Payment Gateway: Moving Stored Cards, Tokens & Recurring Payments
• Merchant Account Underwriting
• Payment Provider Risk Appetite
• PCI DSS Compliance Guide
• Merchant Account Fees Explained
• High-Volume Merchant Processing

How Merchant Advice Service Helps Healthcare Businesses

Merchant Advice Service is an independent UK payments information, comparison and provider-matching service.

We can help healthcare businesses understand their payment requirements before identifying potentially suitable provider routes.

This can include:

• merchant accounts;
• card terminals;
• payment gateways;
• practice-management integrations;
• booking-system payments;
• payment links;
• MOTO;
• recurring payments;
• higher-value transactions;
• multi-site healthcare groups;
• merchant-account underwriting;
• provider risk appetite;
• reviewing existing processing costs;
• switching payment providers; and
• more complex integrated payment requirements.

The aim is to understand how the healthcare organisation actually takes payments before comparing providers.

Final merchant-account acceptance, pricing, settlement, underwriting and commercial terms remain with the relevant payment provider.

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Sources and Reference Organisations

• NHS – patient services, NHS dental, optical and travel-health information
• NHS England – primary care and healthcare-service information
• British Medical Association – GP contractual and non-NHS fee guidance
• Care Quality Commission – regulation of health and social-care services in England
• General Dental Council – professional standards for dentistry
• Royal College of Veterinary Surgeons – veterinary professional standards and guidance
• General Optical Council – standards for optical professionals and businesses
• Information Commissioner's Office – UK data-protection guidance
• PCI Security Standards Council – PCI DSS standards and resources
• Financial Conduct Authority – consumer-credit and finance regulation where relevant

Editorial disclosure: Merchant Advice Service references healthcare organisations, software companies and payment providers where they help explain sector-specific payment requirements. Inclusion does not constitute a recommendation or ranking. Payment integrations, provider appetite, functionality and commercial terms can change and should be verified before making a decision.

This guide provides general payments information and does not constitute medical, legal, regulatory, tax, data-protection or compliance advice.