Managed care programs establish procedures to help their patients avoid use of psychiatric emergency services. To determine whether managed care patients who do visit the emergency service do so primarily for hospitalization and have briefer contacts with the service because of preapproval for hospitalization, records were examined for 293 patients who visited a psychiatric emergency service; 69 were enrolled in a managed care plan. The findings did not confirm the expectations: many managed care patients received crisis services and were referred for outpatient care. The non-managed-care group had more psychotic and substance use disorders, required more emergency community intervention, and had more previous psychiatric hospitalizations.