Our dog needed knee surgery to repair a torn ACL. We received an estimate from the vet and submitted this to Trupanion for pre-approval. They ok'd the pre-approval to cover 90% of the estimate and we scheduled the surgery for the following week. The vet clinic had worked with TruPanion before so the entire process was very easy. We did not have to pay the entire amount up front, only the 10% amount that we owed.