Dental Insurance Reimbursement: Why the EFT Push Matters to Your Practice

By Megan Wyrick, Orthodontic Financial Consultant & Co-Founder, The Wyrick Outlook

Here is the short version. Dental insurance reimbursement is being pushed off paper checks and onto electronic funds transfer (EFT), and the switch is not as clean as the payers make it sound. In 2026, Delta Dental started moving providers away from paper checks, and the American Dental Association started pushing back in public. If you run the money side of a practice, this decides how fast you get paid, how much labor it takes to post that payment, and how much of what you earned actually lands in the right patient’s ledger.

One note before we go further. The Wyrick Outlook is orthodontic-specific. We coach ortho teams, and through twoDO we handle remote insurance billing (insurance only, and our team is 100% US-based). We use the broad “dental” language here because that is what most practice owners search, but everything below is written for orthodontic practices and the codes, work-in-progress claims, and payment posting that come with them.

How do dental practices get paid by insurance?

Dental practices get paid by insurance in one of two ways: a paper check mailed with the explanation of benefits, or a direct EFT deposit into the practice bank account with the remittance delivered separately through an online portal.

Both are legitimate dental insurance payment methods. The difference is not the money. The money is the same either way. The difference is the work it takes to turn that money into a correctly posted account, and that is the part almost nobody puts a number on.

Here is the quick breakdown of how insurance reimbursement reaches an ortho practice today:

• Paper check plus a paper or PDF explanation of benefits (EOB), posted from one document
• EFT deposit into the bank, with an electronic remittance advice (ERA) pulled from the payer portal
• Virtual credit card (VCC), where the insurer sends a one-time card number the practice keys in like a patient payment

What changed in 2026: Delta Dental’s EFT push and the ADA’s response

This year the quiet default flipped. Delta Dental’s own EFT page now states that practices who decline EFT enrollment and keep receiving paper checks will be charged a $15 weekly paper-check processing fee, beginning January 1, 2027 (Delta Dental). That is the “insurance charging for paper checks” story you may have heard about. It is real, and it is written down.

The American Dental Association came out against it. In July 2026, ADA News reported that the association opposes insurers charging fees for paper checks, and quoted Dr. Shelley Olson, chair of the ADA Council on Dental Benefit Programs: “Charging for paper checks increases the costs for patients to receive healthcare and for providers to administer it” (ADA News, July 2026). In a July 8 letter to state insurance commissioners, the ADA argued that dentists should keep the freedom to choose their payment method and receive the full value of their reimbursement without extra administrative fees.

So we have a payer telling practices to enroll in EFT or pay to keep paper, and the national association telling practices this shifts cost and work onto the office. Both things are true at once. A practice can save the $15 a week and still end up spending more, because the fee is the visible cost and the labor is the hidden one.

We first heard Delta and a few other carriers were moving this way at the start of the year, and we have watched it closely ever since, because until now no carrier had put out concrete guidelines on the EFT push. Several of the offices we work with have already told us this is going to cause chaos for them from an administrative standpoint, and they are coming to us for advice on it. We have also reached out to the ADA to see whether practices can take a proactive stance and act on this before it becomes the norm.

EFT vs paper check: the real dental insurance reimbursement tradeoff

Most write-ups on EFT vs paper check for dental stop at “EFT is faster.” It is faster. That is not the whole ledger. Here is how the two payment methods actually compare on the work your team does, not just the speed of the deposit.

What you are comparing	Paper check	EFT (electronic funds transfer)
Posting labor	Check and EOB arrive together, so staff post from one document	Deposit hits the bank first and the remittance lives in a separate portal, so staff reconcile the two before posting
Reconciliation steps	Usually one payment, one EOB, one or a few patients	One bulk deposit often covers many patients across plans, matched line by line
Speed of funds	Slower (mail plus deposit)	Faster, often several days sooner
Fees	Historically none, though some payers now add a paper-check processing fee*	No paper fee, but virtual credit card variants can pass the card processing fee to the practice
Error and missed-posting risk	Lower per payment, higher if unposted checks pile up	Higher when a bulk EFT is posted in a hurry or an ERA is missed entirely

*Delta Dental’s EFT page lists a $15 weekly paper-check processing fee starting January 1, 2027. Fees, effective dates, and rules vary by payer and by plan, so confirm the terms with each payer before you decide.

One more caveat the clean version of this table hides: EFT is faster on paper, but whether it is faster in your practice depends entirely on how clean your ERA-to-PMS connection is. A tidy auto-post setup in Cloud9 or Ortho2 Edge is a different animal from a team downloading remittances by hand.

Why we still prefer paper checks (the reconciliation nobody counts)

Here is our honest take, and it is not the popular one: for a lot of the practices we bill for, we still prefer paper checks. Not because we are afraid of technology. Because of the labor to reconcile and post an EFT.

Posting an EFT is not “the money arrived, mark it paid.” A bulk EFT deposit is one lump sum that can cover a dozen patients across several plans. Before anyone can post a dollar correctly, the team has to log into the practice bank account to confirm the deposit actually cleared, then log into each insurer’s portal to pull the remittances that make up that lump sum, then match every line back to the right patient and the right claim. Only then does posting begin.

With a paper check, the payment and the EOB show up in the same envelope. The reconciliation is mostly done for you. The payer moving to EFT does not remove that reconciliation work. It moves the work from the payer’s side to yours. You are now doing the sorting the insurer used to do, on your team’s clock, and that shows up as labor cost and slower posting, not as a line item anyone bills you for.

That is the part the “EFT saves you time” pitch skips. It saves float time on the deposit. It can add posting time on the back end, especially for a short-staffed office or one mid-transition after an insurance coordinator left. Accurate posting is also downstream of accurate insurance verification; if the front end was sloppy, the EFT reconciliation is where that mess finally surfaces.

In our own billing work, posting an EFT takes about three times as long as posting a paper check. For an EFT, the financial coordinator has to log into the bank account, confirm the funds actually landed, then log into the insurance portal, clear multiple two-step authentications, hunt down the EOB, and post it to each individual chart. With a paper check there is none of that, no bank confirmation and no portal logins, because the payment and the EOB arrive together.

When EFT actually makes sense

To be fair, EFT is the right call in plenty of cases, and pretending otherwise would be dishonest.

If your practice has a clean ERA feed that auto-posts into your PMS, a competent insurance coordinator who is not drowning, and payers whose portals work with your software, EFT is genuinely faster and the reconciliation load is manageable. Cash flow improves because the money is not sitting in the mail. For a well-staffed office with tight systems, the $15 weekly paper-check fee is not worth paying to keep an envelope.

The trouble is that a lot of practices are not in that position. They are short-staffed, mid-transition, or the person who understood the portals just walked out. In that state, being forced onto EFT means the reconciliation work lands on a team that already cannot keep up.

EFT is the better choice when a practice has three things: streamlined systems, a dedicated insurance coordinator who can post on a weekly basis, and a doctor who is comfortable giving the team view-only access to the bank account. Most practices do not have all three, and that is why, for most of the offices we work with, paper checks are still the preferred method.

Reimbursement is a collections problem, not a payments one

Step back and the payment-method fight is really about something bigger. Getting a reimbursement posted correctly and on time is not an accounting chore. It is a collections problem. This is the whole idea behind Collections First: production means nothing without collections, and reimbursement that is posted late or posted wrong is exactly where collected revenue quietly leaks out of a practice.

Think about where the leaks live. A bulk EFT gets posted in a rush and one patient’s payment lands on the wrong ledger. An ERA gets missed, so a paid claim still shows as outstanding and nobody follows up. Posting falls a week behind, so the aging report lies and the team chases balances that were already paid. None of that is a “payment method” problem. It is a posting-and-reconciliation problem, and it is where money you already earned goes missing.

That is why the EFT question matters beyond the $15. Whatever method a payer forces on you, the discipline is the same: deposits confirmed, remittances pulled, every dollar matched to the right account, aging that tells the truth. Get that right and you protect both your cash flow and your long-term practice growth. Get it wrong and no reimbursement speed saves you. If you would rather build the muscle in-house, orthodontic insurance billing training teaches the insurance coordinator role, and financial coordinator training covers the collections and posting side for the FC.

Frequently Asked Questions

Can a dental insurance company charge you for a paper check?

Yes, some now do. Delta Dental’s EFT page states a $15 weekly processing fee for providers who decline EFT and keep paper checks, starting January 1, 2027. The ADA opposes fees like this, but until state regulators or legislation say otherwise, the fee stands where the payer has set it. Check each payer’s terms directly.

Is EFT or paper check better for a dental practice?

It depends on your systems and your staffing, and anyone who gives you a flat answer is selling something. EFT is faster and avoids the paper-check fee, and it works well when you have a clean ERA-to-PMS auto-post setup and a coordinator who is not underwater. Paper checks keep the payment and the EOB together, which cuts the reconciliation work, and that can be the better call for a short-staffed office or one in transition. Weigh the fee against the labor, not just the speed of the deposit.

How do you reconcile a bulk EFT insurance payment?

A bulk EFT is one deposit that usually covers many patients across different plans, so reconciliation is a sequence, not a single step. First, log into the practice bank account and confirm the deposit actually cleared and for how much. Next, log into each payer’s portal and pull the electronic remittance advice (ERA) for every claim inside that lump sum. Then match each line, by patient and by claim, to what you expected, flagging any short-pays or denials. Only after all of that do you post to each patient’s ledger. If your PMS auto-posts from the ERA, software handles the matching and your team audits the exceptions, which is where clean setup pays off. Skip or rush any step and you get misposted payments and an aging report you cannot trust.

What is a virtual credit card payment from a dental insurer?

A virtual credit card (VCC) is a one-time card number the insurer sends instead of a check or EFT, and your team keys it in like a patient card payment. The catch is that VCCs can pass the card processing fee to the practice, so you can lose a slice of the reimbursement to fees. Many practices opt out of VCC and choose EFT or paper instead.

Does The Wyrick Outlook handle EFT payment posting?

Yes. Through twoDO, our remote billing team posts and reconciles insurance payments (EFT and paper) inside your existing practice management software, so deposits get confirmed, remittances get pulled, and every dollar lands on the right account. We are insurance-only and 100% US-based. See our remote billing services for how it works.

About the Author

This article was written by Megan Wyrick, Orthodontic Financial Consultant and Co-Founder of The Wyrick Outlook. Megan has more than 15 years of hands-on experience inside orthodontic offices, working in scheduling, financials, marketing, and treatment coordinating, with a focus on the dollars side of the practice: insurance billing, collections, AR, and financial systems. She and her sister have partnered with more than 450 orthodontic practices. Learn more about Megan and the team.

Posted by Megan Wyrick