Zelis Insurance Coverage for Addiction Treatment

Does Zelis Insurance Cover Alcohol and Drug Rehab?

The Affordable Care Act requires all health insurance plans to cover mental health services, including the treatment of substance use disorders. This means that private healthcare plans need to provide some degree of coverage for addiction treatment.1 

Zelis insurance is a network of over 700 payers, one hundred million members, and millions of providers. Established in 1995 under the name Stratose, this provider offers different levels of coverage to members in Georgia, New Jersey, Kansas, Missouri, and Florida.2

How to Check Zelis Insurance Coverage for Addiction Treatment?

If you wish to use your Zelis insurance coverage for addiction treatment, you need to contact the company by calling the number on the back of your card. You’ll talk to an operator who’ll let you know what extent of coverage you can expect. You can also use the company’s website to find in-network providers.3 

American Addiction Centers also provides patients with a hotline service. You can have a confidential conversation with our admissions navigators, find out if our centers are in your carrier’s network, and learn more about our intake process. Apart from carrying out Zelis Insurance verification, they’ll also tell you what to expect from our admissions process and help you take the first steps toward sobriety.

What is Zelis Insurance?

Zelis insurance is a company providing health insurance plans to millions of members. It has been operating since 1995 in the fields of medical services, dental care, and workers’ compensation. It brings together payers, healthcare professionals, and members to offer affordable, easily accessible, and high-quality care.4 

What Is Included in Zelis Health Plans?

Your Zelis health plan will cover some aspects of drug rehab. However, this doesn’t necessarily mean that the cost of your drug addiction treatment will be covered in full. Depending on your level of coverage, there may be different deductible and copay amounts.1 

Members need to verify their insurance beforehand. You can do this by calling the Zelis hotline and talking to their representative.2 Alternatively, you can call the American Addiction Centers’ helpline to check if our center is in the Zelis network and what portion of your treatment could be covered.

What Will Zelis Insurance Cover?

Zelis insurance can cover some or all of the costs associated with your substance abuse treatment, such as:5

• Detoxification: People struggling with addiction initially need to go through drug detox to eliminate the substance from their system. These programs may span only 3, 5, or 7 days, or they can last significantly longer. Rehab facilities provide a safe and comfortable environment to do so and they’re often located in beautiful, serene settings.
• Stays at an inpatient facility: Those who need intensive treatment usually benefit from spending some time in an inpatient center. There they can be dedicated to their recovery 24/7 thanks to the safe and stimulating environment and round-the-clock professional supervision.
• Partial hospitalization programs: This is a step-down from inpatient treatment because it doesn’t involve a full-time stay at the facility. Instead, the patient spends time there every day for most of the day, but comes back home at night.
• Outpatient services: At this level of care, patients undergo treatment at the facility several times a week. It’s usually suitable for someone who has already completed an inpatient or PHP treatment program, or has less extensive treatment needs.
• Intensive outpatient treatment: These programs are similar to standard outpatient treatment because patients participate in it while living at home. The difference is that they’re more time-intensive.
• Aftercare management: Once a patient completes other levels of treatment, they still require ongoing support to help them sustain sobriety. Aftercare plans provide them with this consistent care.

Does Zelis Insurance Cover Mental Health Care Facilities?

Some people who struggle with substance abuse also battle mental health conditions. These disorders have similar origins as they can be caused by traumatic experiences and certain genetic factors. People who struggle with their mental health sometimes use drugs and alcohol to self-medicate. Also, substance abuse itself can trigger or exacerbate mental health conditions.6 

Since it’s common for substance use disorders to co-occur with mental health problems, it’s important to give treatment-seekers access to quality, comprehensive dual diagnosis treatment. A professional evaluation of the patient’s condition determines what type of substance abuse treatment they need and whether there are any co-occurring conditions that should be addressed.6

All health insurance providers have to match mental health coverage with the coverage of other medical conditions. Zelis insurance also has a mental health provider list of facilities that diagnose and treat behavioral health.1 

How Long Does Zelis Insurance Cover Rehab?

The duration of a patient’s treatment program depends on factors like the intensity and duration of their addiction, their medical condition, and the presence of co-occurring disorders. In general, people with more extensive treatment needs and severe medical or psychological problems require care for longer. For example, they may stay at a residential facility for 60 days or be in inpatient care for 90 days or longer. Also, a longer course of treatment has been shown to contribute to successful recovery.7

Zelis insurance will cover your drug treatment at least to an extent. Their representative can let you know what degree of coverage you can expect. Contacting Zelis healthcare to discuss your plan and benefits is the first step in the process of seeking treatment.2

What if My Zelis Policy Does Not Cover Rehab?

Your Zelis health plan will cover at least a part of the cost of your drug rehab. The Affordable Care Act requires insurance carriers to match their mental health coverage to the coverage of other medical services. However, not all elements of drug treatment will necessarily be included in your benefits package.8 

You can perform Zelis insurance verification by contacting the company directly. If your treatment isn’t fully covered, you will have to cover the remaining expenses yourself. However, there are different ways to finance it, including loans, scholarships, and grants.9

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

While Zelis insurance works with certain rehab centers nationwide, the locations of these facilities may not suit you, especially if you need residential treatment, and you may want to consider out-of-network providers. While choosing an in-network provider typically means that more of your expenses will be covered, some Zelis plans may also offer the possibility of picking an out-of-network facility. You can locate Zelis rehab facilities by using their provider directory.3