My almost 6 year old amstaff mix had a dying tooth (pulpitis). Extraction was possible but a root canal was recommended because it was a large canine tooth. That meant $2500+ all told.
Trupanion rushed to get vet records from two hospitals and pre-approved the claim between a friday pre-surgery exam when I first got the estimate, and the root canal the next wednesday.
Trupanion covered everything except a $24 acupuncture needle (I declined a rider that covered acupuncture and other extra treatments) and sent out a check for nearly $1800 the day after I submitted the final invoice (I chose a $500 deductible with 90% coverage to keep premiums down).
I was already stressed about my girl having general anesthesia and a surgical procedure, but Trupanion took away all the stress about money. They were helpful, caring, responsive, and informative and I'm so glad I was insured with them!
And a bonus - Trupanion's deductible is lifetime per-condition, not annual or per-visit, so now that I've met the deductible they will cover 90% of her followup visits related to this condition and surgery! They let me give her the best, vet-recommended care without worrying about whether I can afford it.
I can't recommend Trupanion highly enough after this experience, especially compared to stories I've heard about other pet insurance.