I took out accident insurance on my young dog and accident/medical on my old dog. Soon after the former was bitten badly by another dog and the latter suddenly became incontinenent (bowel and bladder) and later had to be euthanized. I ended up actually getting paid more than I had paid to date for their insurance. I did not question the reimbursement amount because I was grateful for the help I did get. My understanding of this insurance is that they pay 80% of the charges they approve (just like human medical insurances) not a flat 80%. Since I have not investigated reimbursements by other pet insurers, I cannot comment on ASPCA's approval of charges factor.