Just like with human health insurance, one never knows how pet insurance really works until you have to use it. My dog, Kieran, was diagnosed with an autoimmune disease two months ago. It took Trupanion about 2 weeks to act on my claim, waiting for my vet to submit Kieran's entire medical history to them. Once this had been completed and I had met my deductible, Trupanion started sending me checks to reimburse me for payments to my vet (five visits so far). Now my vet is submitting the claim, getting confirmation from Trupanion, and reducing my bill by my co-payment percentage -- all while I wait (5 minutes max, so far...) I am very amazed, and very pleased, with their service. Kieran's blood platelet count will have to be monitored for the rest of his life, and I have confidence that Trupanion will continue to cover those expenses.