Although a substantial body of literature indicates that specialized treatments, usually of a behavioral nature, are available with comparatively superior outcome, much of this information is clinically under-utilized across a wide range of disorders. Until recently, there were few incentives for clinicians to apply state-of-the-art procedures to their clients' problems. Sweeping changes in the health insurance industry, however, are leading to a proliferation of managed mental health care companies driven by economic forces to deliver the most effective and efficient (and therefore most profitable) forms of care. The present paper discusses the history and development of these insurance changes and their implications for the future utilization of behavior therapy.