This paper explores the extent to which third-party reimbursement dictates occupational therapy practice. A literature review was used to examine the history and meaning of reimbursement in regard to occupational therapy. It was found that the profession has altered its definition, practice, management, ethics, and professional response as a result of changes in reimbursement. Reimbursement policies reflect societal influences and are shaping occupational therapy in several ways. Control has shifted to third-party payers, allowing them to define occupational therapy; use of the medical model is being rewarded by reimbursement; the language used to discuss the profession has changed to accommodate the insurance and other industries; and values that dominate society are being reinforced. Conflict between the values of society and the values of the occupational therapy profession is a source of struggle for many clinicians. If the causes of the reimbursement-imposed constraints on practice are understood, occupational therapists will be free to be proactive in issues of health care policy.