Top 3 Telemedicine companies, what technology they use for video streaming?

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Nowadays Telemedicine platforms boom due to well-known reasons.

In this article, we are going to review the biggest Telemedicine platforms, find out what they use for video calls and calculate their average expenses per month specifically for video calling infrastructure.

According to the almighty Google, Top 3 biggest Telemedicine platforms are 


3000 employees


521 employees


396 employees

After a short investigation, we found out that those platforms use different video streaming software.

Teladoc uses Vonage CPaaS video streaming service provider. MDLive works with Twilio 

And looks like Amwell works with a custom WebRTC video calling implementation they acquired from Aligned Telehealth.

So how many patients make virtual visits on those platforms? 


TelaDoc says in 2020 they had between 9.8 and 10.3 millions of visits. Amwell stated they got 1,414 mln in Q3, so we will round that up to 5.6 mln in 2020. And MDLive mentioned 7.5K visits per day, that’s roughly 2.7 mln visits per 2020.

Number of visits per 2020


10 mln


5.6 mln


2.7 mln

What would be the costs for the video calls infrastructure? 

According to statistics, every visit lasts on average around 15 minutes.

Teladoc uses Vonage and their pricing is $0.004/subscribed minute. What does it mean? Well, if you have 2 users on a call, you would need to pay $0.004/minute * 2 users = $0.008/minute. And now we will multiply by average visit 15 minutes and we get $0.008/minute * 15 minutes = $0.12/visit. So for the whole year, Teladoc paid to Vonage 10 mln visits * $0.12/visit = $1.2 mln. 

For your information that’s the base price only. For sure they used an Enterprise support plan, which costs additional funds. Probably they make video recordings which could add at least the same amount of costs.

MDLive is using Twilio. And Twilio has a special price for peer-to-peer video calls, which is $0.0015 per minute. Ok, with the two participants, one video call will cost $0.0015/minute * 2 = $0.003/minute, and then multiply by 15 average visit minutes, $0.003/minute * 15 minutes = $0.045 for a visit. That’s roughly 3 times less than Teladoc pays. And for the 2020 year, MDLive spent around 2.7 mln * $0.045/visit = $121K.

Again, this is a base price. And maybe some calls contained more than 2 participants. Again, probably they store recordings, and those conditions will increase the costs several times.

Now let’s calculate Amwell’s costs. They use a custom WebRTC implementation, meaning they are running their own servers. They had 7500 visits per day on average. I would guess during peak times they would handle 3000 visits per hour. For that amount of users, they would keep 10 web servers, and 30 so-called TURN servers running. For calculations example let’s use the OVH cloud server provider, they have free bandwidth included. From OVH we can rent “Elite” server for $34/month. 40 servers * $34/server = $1.4K/month. Or $1.4K/month * 12 months = $16.8K per year.

This is a base price. It doesn’t keep any recordings or any advanced functionality. 

In general, the 3-rd party services like Vonage or Twilio will provide you with the stability, but if you set up your own custom servers right, it would work as great.

I hope you can get an understanding what are the costs for the leading companies to handle their video calling infrastructure.

In case you would like to buy a ready custom WebRTC platform for peer-to-peer calls, send me a message:


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