Zelis Insurance Coverage for Substance Abuse Addiction Treatment

Zelis Insurance Coverage for Rehab and Detox Near Me

Zelis is a nationwide insurance provider offering plans that cover detox and other forms of addiction treatment. While an insurance plan, whether that of Zelis or another company, may offer coverage for certain treatments, including detox or rehab, this is not a guarantee that your Zelis plan will pay for your treatment.
Yes. Zelis Insurance covers drug and alcohol rehab.
TreatmentSolutions.com strives to provide you with the most updated information on each carrier's addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.
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Does Zelis insurance cover Alcohol and Drug Rehab?

Zelis Healthcare assists payers and providers with healthcare plans by simplifying the process and facilitating payments.1 They have providers across the United States. So, everyone can access a Zelis health plan.2 If you have an alcohol or drug misuse issue, you can seek treatment using your Zelis insurance coverage.

Contact the rehab facility you plan to attend, and they will verify your insurance coverage based on the information you provide. If you want to contact your insurance company, you can check the contact number on the back of your insurance card and obtain more information about your specific policy.

Check Zelis Insurance Coverage for Addiction Treatment

You can check your Zelis insurance behavioral health coverage easily by contacting the American Addiction Centers (AAC) helpline. AAC is a well-known, top-quality treatment center, with locations nationwide. When you call the helpline, you can talk to an admissions navigator who will check your Zelis plan and verify your insurance benefits. They will also check the locations of rehab facilities near you.

If you’d rather get an answer about your insurance immediately, you can fill out the form on this page and find out if your benefits are in-network or not.

What is Zelis Insurance?

Founded in 1995, the company began as Stratose. In 2015, the company was branded under the name Zelis and offered users a “single-source solution” to healthcare.3(top) They have offices in Georgia, New Jersey, Kansas, Missouri, and Florida.3(bottom)

Zelis insurance works with payers, providers, and healthcare consumers to deliver a product that assists with every step of the healthcare process. With over 700 payer clients and 1.5 million providers, they are making their mark in healthcare.3(top)

Zelis Health Plans

Zelis insurance plans are offered as “solutions.” The solutions they provide for members who need care include:

  • Network Solutions: This plan assists with tracking competitor activity and marketplace plans to give the member the best solution for their situation. Members receive access to primary and supplemental networks.4(network)
  • Out-of-network solutions: With this service, members will have help with claim negotiations and marketplace plan pricing. The result is savings on out-of-network services.4(out of network)
  • Payment integrity: The final piece of the puzzle in Zelis health insurance is the payment integrity piece. With this, members have bills reviewed and claims edited.4(pay integrity)

What will Zelis insurance cover?

Your Zelis insurance rehabilitation coverage may vary in what it will cover, depending on various factors. Your length of stay and the intensity of the rehab will determine some of the coverage and cost factors.

Zelis insurance drug rehab offers a variety of treatment levels that deliver a continuum of services. Your Zelis rehab insurance should cover some of the cost of the following treatments:

Inpatient/residential rehab: An inpatient treatment program is similar to a residential program, with around-the-clock care. Clinicians are on hand to assist you with the withdrawal symptoms you may experience, giving you medication if needed. This treatment program may last for a short time, such as a few days or a week, or it could be a few months or more.5

Partial hospitalization programs (PHP): When participating in a PHP, you will also get the same amount of care as an inpatient program. You’ll have clinical supervision and therapeutic support surrounding you. The only difference is you will go to your residence at night.6

Intensive outpatient programs (IOP): During an IOP, you will begin outpatient therapy, but it is more intensive than a regular outpatient program. Sessions are usually several hours a day and may include most days of the week.5

Outpatient rehab/therapy: When you begin your outpatient program, you’ll be ready for more independent living. Yet, you benefit from the techniques you’ll learn to help with relapse prevention.5

Does Zelis Insurance cover behavioral health?

Part of a rehab program will have a component that focuses on behavioral health. Evidence-based therapy is a critical part of recovery in rehab. Some of the main therapies that are used when treating a drug or alcohol addiction are:7

  • A 12-Step program.
  • Family therapy.
  • Motivational enhancement therapy.
  • Contingency management interventions.
  • Community reinforcements.
  • The Matrix Model program.
  • Cognitive-behavioral therapy.

You can check your Zelis insurance rehab coverage to determine what therapies are covered under your plan. Most insurances will have outpatient therapy cover, but there may be copays, coinsurance, and deductibles.

What types of substances does Zelis Insurance cover?

When participating in one of the Zelis Insurance drug treatment programs, you can expect to find treatment for most substances that people misuse. Different types of substances have different reactions to the body and brain. So, you could contact the Zelis insurance hotline to find out if the particular substance you are using is one that the rehab treats if you’re concerned about it.

Commonly used substances in the U.S. include the following:8

  • Adderall
  • Alcohol
  • Cocaine or crack
  • Heroin
  • Ketamine
  • LSD
  • Marijuana
  • MDMA
  • Opioids
  • Prescription painkillers

Does Zelis Insurance Cover Mental Health Care Treatment Facilities?

Check with your Zelis insurance mental health coverage if you are experiencing a co-occurring disorder with substance use and mental health disorders. These 2 conditions commonly occur, leading to the need for a co-occurring disorder treatment program.9

Any mental illness may co-occur with substance abuse. However, some mental health disorders are more prevalent with substance use than others.10 These include the following:10

  • Depression
  • Bipolar disorder
  • Attention-deficit hyperactivity disorder (ADHD)
  • Psychotic illness
  • Borderline personality disorder
  • Antisocial personality disorder

If you want to treat both conditions (mental health and substance use), it is recommended, and you have the protection of federal laws that ensure insurance companies don’t deny people due to addiction issues.11 &12 One law is the Mental Health Parity and Addiction Equity Act of 2008. This law indicates that insurance companies must treat mental health and substance misuse claims in the same way they do medical claims.11

In addition, the Affordable Care Act of 2010 states that insurance providers must allow coverage for essential benefits, which include mental health care and substance abuse treatment.12 So, Zelis Insurance substance abuse treatment coverage treatment and a stand-alone drug or alcohol rehab fall under this mandate.

How Long Does Zelis Insurance Cover Rehab?

Obtaining the appropriate amount of time for Zelis Insurance drug treatment is vital for adequate recovery. Having an admissions navigator give you Zelis Insurance verification will answer some of your questions about the length of time that will be covered. However, you may want to determine how much time you will need in a rehab program first.

Recovery is a unique journey for every affected person. Every path may look a bit different from another person’s path. However, experts do recommend that staying in an inpatient rehab should last at least 3 months.13

What if my Zelis policy does not cover rehab?

If your Zelis insurance benefits don’t take care of all the costs of rehab, you don’t need to give up. You have financial options. Check with any of the Zelis Insurance drug treatment providers in your area about financing or scholarship programs available. Find out what you need to do to apply for financial aid or a scholarship. Sometimes people don’t receive help because they don’t ask. It’s better to inquire than to push off seeking treatment to a later date.

Zelis Insurance In-Network vs. Out-of-Network Rehab Centers

You can find an in-network PPO Zelis Insurance rehab center by checking the search provider directory. An in-network PPO will offer doctors, clinics, and facilities that are within your provider group.

You can still work with out-of-network providers with a Zelis Insurance rehab plan. Zelis has several out-of-network solutions.

Sources

  1. Zelis. (n.d.). Health plans.
  2. Zelis. (n.d.). State specific network provisions.
  3. Zelis. (n.d.). About us.
  4. Zelis. (n.d.). Solutions.
  5. National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction DrugFacts.
  6. National Institute on Drug Abuse. (2020). Treatment settings.
  7. National Institute on Drug Abuse. (2020). Behavioral therapies.
  8. National Institute on Drug Abuse. (2020). Commonly used drugs charts.
  9. National Institute on Drug Abuse. (2018). Comorbidity: Substance use disorders and other mental illnesses DrugFacts.
  10. National Institute on Drug Abuse. (2021). Part 1: The connection between substance use disorders and mental illness.
  11. FindTreatment.gov. (n.d.). Paying for treatment.
  12. HealthCare.gov. (n.d.). What marketplace health insurance plans cover.
  13. National Institute on Drug Abuse. (2020). Principles of effective treatment.
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