Why telehealth brands get more 1-star reviews

What we measured

On September 19, 2026 we read the public Trustpilot profiles of 16 well-known direct-to-consumer telehealth brands. One profile could not be loaded. The other 15 held about 118,000 reviews.

The figures for all seven health categories are in the DTC health Trustpilot report 2026.

How we counted. Trustpilot shows the percentage of reviews at each star level. We multiplied that percentage by the review count, so 1-star counts are estimates. Percentages on Trustpilot are rounded. We do not name the brands here, because the point is the pattern.

For comparison, the 15 GLP-1 and weight-loss profiles we read the same week had a lower overall 1-star share, about 6%. Many of them run large invitation programs. See the GLP-1 page.

Cause 1: one purchase, four ways to fail

A retail order can go wrong in one or two ways. A telehealth order has four parts, often run by different companies:

1. a clinician, who may say no
2. a pharmacy, which may be out of stock or slow
3. a carrier, which may be late
4. a billing system, which renews

The customer sees one brand. Any failure in the chain becomes a review of you. Trustpilot treats all of it as a genuine experience with your business, including the partner pharmacy's delay.

Cause 2: subscription billing surprises

The most common 1-star review on the profiles we read was some version of "I did not know it would renew" or "I was charged after I cancelled".

These reviews do not qualify for removal. They are also the ones regulators read. In its final order against NextMed, a telehealth company, the FTC set billing rules. It required clear disclosure of refund and cancellation terms before charging, informed consent before billing, and a simple way to cancel.

What reduces it: the renewal date and amount at checkout and in the confirmation email, a reminder before each renewal, and cancellation inside the account area.

Cause 3: paying for a visit and hearing "no"

In most online purchases, paying means receiving. In telehealth, a clinician can decline to prescribe, and should when it is the right call. Some customers experience that as paying for nothing.

What reduces it: plain wording before payment that a visit does not always lead to a prescription. Add a clear policy on what happens to the fee when it does not.

Cause 4: silence during delays

Medication is time-sensitive in a way most products are not. A customer who is about to run out will write a review at day five that a furniture buyer would write at week five. Many of the delay reviews we read were about silence more than the delay itself.

What reduces it: a shipping update sent before the customer asks, and support response times you can actually meet.

Cause 5: happy patients stay quiet

People rarely post in public about hair loss, erectile dysfunction, weight or mental health. Unhappy customers are less shy. A brand that does not invite reviews ends up with a profile written mostly by its least satisfied customers.

Trustpilot marks this. Some profiles in our sample carried the notice: "No recent history of asking for reviews. This company hasn't invited customers recently, so reviews may not be representative."

The formula matters here too. TrustScore gives more weight to recent reviews and is steadiest when reviews arrive regularly. In our sample, one profile with a 39% 1-star share still had a TrustScore of 4.1, because of how recent reviews are weighted.

What reduces it: fair invitations to every customer, at the same point in the journey, in neutral words. Trustpilot's rules ban incentives and picking only happy customers. If you are a covered entity, ask your privacy counsel about Trustpilot's HIPAA Business Associate Addendum before sending invitations.

Cause 6: replies that cannot say much

A retailer can answer a complaint with the facts of the order. A telehealth brand cannot. Confirming that the reviewer is a patient, or mentioning their treatment, can disclose protected health information. HHS settled a case for $30,000 with a provider that did this in replies to reviews.

So readers often see a detailed complaint next to a short, general reply. That is the correct reply, and it still reads as weaker than the complaint.

What reduces it: replies that explain the policy in general terms, show that a private channel exists, and are posted quickly. See HIPAA-safe replies.

Where removal fits

Most of the reviews described above are genuine and stay online. Inside the same profiles there is a smaller group that breaks Trustpilot's rules:

• reviews that publish a clinician's or agent's name and contact details
• reviews that advertise another provider with a code or link
• reviews about a drug or service the brand does not offer
• reviews that describe someone else's experience
• reviews by employees or competitors

Those can be flagged, with evidence that stays outside the patient file. The telehealth page explains how, and the main Trustpilot review removal page covers the five flagging categories.

Removal and prevention work on different reviews. A brand that does both sees the rule-breaking reviews come down and fewer new complaints arrive. A brand that only flags will see the same complaints return next month.

To find out which of your reviews fall into which group, request a free audit.

We do this work for clients through our Trustpilot review removal service, and the price per removed review is published.