This article addresses the effect of managed care on the treatment of eating disorders. We review strategies for negotiating limitations that managed care reviewers place on treatment. Finally, this article reviews the experiences of a Canadian program that has 10 years of experience in providing low-cost day treatment. While change is frustrating and difficult, it is inevitable and can be rejuvenating. These changes offer opportunities for creative development of quality low-cost care. If we do not adjust to these conditions, patients will not get treatment that they need.