In this qualitative study of managed health care and occupational therapy practice, participants described how their practice had changed, suggested that students be educated to communicate the value of occupational therapy and to navigate corporate medicine, and expressed ethical concerns regarding reimbursement versus therapy goals. In-person, individual, focused interviews were conducted with 25 therapists in the southeastern Atlantic states. Participants’ perceptions of pervasive changes in practice due to managed health care reflected three themes of meaning: the “pushing against it” personal–professional struggle; the “going with it” businesslike perspective, and the “making the best of it” optimistic outlook. These findings provide insight into therapists’ occupational adaptation to managed health care.