Zelis Insurance Coverage for Rehab and Detox

Does Zelis Cover Rehab?

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.

How Do I Use My Zelis Coverage for Detox?

To use your Zelis insurance coverage to pay for rehab you will need a pre-authorization for services by contacting Zelis directly. Depending on your situation, the type of drug or alcohol treatment 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 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.

How to Check Your Zelis Rehab Coverage

You can check your coverage online by visiting the Zelis 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 for rehab in that state. Generally speaking, however, you can expect Zelis to cover some portion of the following rehab services:

How Much Will Rehab Cost With Zelis Coverage?

Some treatment centers 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 detox or rehab than if you go to a Zelis network provider.

Even for covered addiction therapy services, most insurance plans, including those offered by Zelis, have deductibles and co-pays. In addition to varying deductibles & copays, the cost of detox will vary depending on your provider.  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.

If you go to outpatient rehab, many plans will require a co-pay of $25 to $50 per outpatient therapy 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.

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.

Finding Detox Centers who Accept Zelis

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 providers offering rehab coverage, including Zelis. You may call our detox helpline or text us to speak with our rehab admissions navigators for more information or review the following guides on how to choose a rehab in your state.