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Payment processing feels like back-office admin—until fees creep up or your account gets flagged.
In this episode, I sit down with Adam Castillo to talk about merchant services, hidden fees, high-risk rules, and what can put a med spa on the MATCH list. We also cover telehealth, weight loss, website language, and how to protect your ability to get paid.
Know Your Effective Rate
Don't just scan the statement for one fee. Divide total processing fees by total payments processed and track that effective rate over time. Small increases compound fast, and junk fees can eat into margin.
Check the Risk Before You Add the Service
Before launching telehealth, medical weight loss, or a new payment setup:
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Review website and invoice language
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Confirm processor rules for your services
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Ask whether LegitScript or extra underwriting applies
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Audit fees before switching
A cheaper processor isn't a win if the account gets shut down.
(00:05:35) Finding hidden processing costs (00:08:07) Understanding telehealth restrictions (00:16:03) Avoiding risky payment language (00:42:21) How AI scans websites for flagged terms
Your Processor Should Understand Your Business
Med spas don't have the same risk profile as every other business. Work with someone who understands healthcare payments and can help you address issues before they become shutdowns.
Protect How You Get Paid Before You Scale
Expansion gets harder when you can't reliably accept cards. Clean up fees, compliance, and processor relationships now so payment risk doesn't slow your growth later.
About Adam Costilo:
Adam Costilo is a serial entrepreneur who's had a love for business, growth, and the pursuit of the American dream for as long as he can remember. From co-founding a Philly cheesesteak franchise to launching multiple ventures across different industries, Adam has spent his career building things from the ground up — and helping others do the same. Today, as the founder of The Payment Doctor, he and his team process for over 600 clinics to the tune of more than $200 million a year, delivering true payment stability and fully transparent pricing to the medical and medspa space. But payments are just the starting point. With deep expertise in the peptide and GLP-1 landscape and strategic relationships ranging from next-level 503A pharmacy pricing to best-in-class technology partners, Adam has positioned The Payment Doctor as a one-stop shop for clinic growth. His real passion — and his "why" — is helping clinic owners scale their practices and improve their financial lives, and that mission has become the driving force behind everything The Payment Doctor stands for.
Connect with Adam:
Website: www.thepaymentdoctor.com
Meet with The Payment Doctor Team
Follow Shannon & Keep What You Earn:
Shannon Weinstein is the founder of a fractional CFO firm specializing in helping 7-figure aesthetics and wellness practices scale with clarity, cash flow, and confidence. She is committed to helping med spa owners understand, fix, and maximize their business's enterprise value, offering actionable advice and resources, including a popular free video series specifically for aesthetics practice owners.
Fractional CFO Services and Executive Financial Review: https://www.keepwhatyouearn.com/
Connect with Shannon: https://www.linkedin.com/in/shannonweinstein
Watch full episodes: https://www.youtube.com/@KeepWhatYouEarn
Listen on your favorite podcast app: https://pod.link/1580071347
Instagram: https://www.instagram.com/shannonkweinstein/
The information shared is for educational purposes only and is not individualized financial advice. Aesthetics practice owners should consult a qualified professional before implementing financial strategies discussed here.
