I ended up at the emergency vet at 1am with my 3 year old dog Sampson who was showing signs of pain but didn't seem to be too bad.. long story short it ended up that his stomach was twisting, and we caught it just as it was starting! We were able to just say do what needs to be done, as Trupanion was available at such a random hour to do a pre-approval for the surgery. I am not sure what I would have done if I had to cover it all out of pocket... I try not to think about it. They explained again what would be covered, and what would not, and there were no surprises once the bill finally came. They covered his xrays, the surgery, the two day hospital stay and even the prescription food for recovery! I can't recommend this company enough!