Zelis Insurance Detox & Rehab Coverage
Zelis insurance was formed in 2016, after the merger of several healthcare companies including Premier Healthcare Exchange, Stratose, GlobalCare, and Pay-Plus Solutions. Zelis provides network management for insurance companies and claims processing.1 Zelis serves 100 million patients nationwide.2 Zelis Healthcare is headquartered in Bedminster, New Jersey, and serves members from every state.1
If you are looking at this page, you may be wondering, is detox covered by insurance? You likely want to learn how Zelis drug rehab coverage works and what does Zelis cover? Does Zelis cover therapy? The purpose of this page is to answer these questions and educate users on how to access Zelis detox coverage and Zelis rehab insurance coverage to obtain insurance coverage for rehab and detox.
Does Zelis Cover Detox?
Does health insurance cover detox? Most insurance plans cover detox and drug rehab and the plans that Zelis offers typically include drug rehab insurance coverage. It is important to note that 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 drug rehab or drug detox. You will need to get authorization for services by contacting Zelis to see if they will authorize your coverage for drug treatment. Depending on your situation, the drug rehab requested by a facility may be approved by Zelis for inpatient or outpatient detox and ongoing rehab. If your family members are listed on your Zelis plan, they will also be able to request Zelis rehab insurance coverage.
Detox can be completed on either an inpatient or outpatient basis and the best option for you will depend on a variety of factors. Zelis may opt to have you try an outpatient program at some point in your treatment. Generally, you will need to go to an inpatient detox program if you have a severe dependence on substances or have underlying medical or mental health conditions.3 (p. 21) After your treatment program of choice has completed an assessment and determines if you need inpatient or outpatient detox, the program can contact Zelis to get authorization for your treatment stay. Some providers are out-of-network with Zelis meaning that the program does not have an agreement with Zelis to charge a certain rate for services. If you go to an out-of-network program, you will usually pay more for treatment than if you go to a Zelis network provider.
Even for covered services, most insurance plans, including those offered by Zelis, have deductibles and co-pays. For example, if your Zelis insurance plan coverage states that you have a $1,000 deductible per year, this means that you pay $1,000 out-of-pocket before your Zelis coverage starts to pay for detox or rehab. Many insurance plans require a co-pay that usually ranges from $100 to $500 for inpatient treatment. Therefore, you will be responsible for this co-pay in addition to your deductible.
If you go to outpatient treatment, many plans will require a co-pay of $25 to $50 per outpatient visit. After you meet your deductible and co-pay, most plans then cover 75% to 90% of the remaining costs, which is known as coinsurance. Even though you may have a $1,000 deductible and a $250 copay for inpatient detox, you do not usually need to pay that money up-front before entering detox. Many detox and rehab programs will offer a payment plan to pay off the portion of detox or rehab that is not covered by insurance. In addition, most plans, including those with Zelis, will have a maximum out-of-pocket expense amount that you pay each year; once you hit this maximum, your insurance will cover 100% of anything over this maximum each year. So, if your out-of-pocket maximum per year is $5,000, you will not pay anything else for the year after your total spending equals $5,000. With some plans, this $5,000 may include your deductibles and co-pays, but for other plans, this out-of-pocket maximum is only your co-insurance rates. You will need to check with your Zelis representative to see what is covered specifically for your plan.
How to Check Your Zelis Benefits
Again, it is impossible to know what Zelis will authorize for the drug rehab or detox that you are seeking until you speak to a Zelis representative. You can start by visiting the provider login to determine if Zelis will cover your treatment. In addition, if you are seeking Zelis out-of-state coverage, you can look at specific programs and in specific states to see if Zelis offers coverage.
Types of Zelis Insurance Plans
Coverage details can be obtained by reaching out to Zelis. Multiple insurance plans are available with various types of coverage. Most insurance plans offer some form of addiction treatment coverage and speaking directly with a Zelis representative can get you the information you need about your specific plan. You can also visit the provider lookup page to find out which doctors, hospitals, drug rehab centers, and detox programs accept Zelis coverage. Zelis works with several provider networks, including Optum.
Zelis Insurance at American Addiction Centers
At American Addiction Centers (AAC), you can use your Zelis insurance coverage to seek treatment at one of our facilities across the United States. At AAC, we offer the latest research-based treatments to help you get the drug rehab that you need and we use the highest standards of safety in our detox and rehab programs. AAC works with many insurance plans, including Zelis. Call AAC today to speak to one of our referral specialists, who can help you get the treatment you need.
- 1. Zelis. (2016). Newly named Zelis Healthcare introduced to healthcare community, offers integrated suite of claims cost containment and payments technology.
- Zelis. (n.d.) Provider network.
- SAMHSA. (2015). Detoxification and substance abuse treatment.