Trupanion pays their claims without hassle. As a medical provider it is nice to deal with an insurance company that pays claims correctly and without having to constantly resubmit. Does pet insurance save you money? Probably not unless your pet has catastrophic health issues. I have been paying for years and nearly cancelled, but kept it going. My dog Maggie developed some tumors, one of which was a malignant mast cell tumor. After the deductible we received reimbursement of 90% of all the expenses within two weeks. It even reimbursed 90% of medication costs.
The real value of having the insurance is you don't have to decide between your pet's health (and/or life) and your finances when your pet needs a lot of medical care.
Things to understand: The policy does not cover for the cost of the initial visit to diagnose the problem. It also has a deductible (you choose the amount which in part determines the monthly rate) which is per condition. Mine is $50.00. So your first visit for a condition will likely not reimburse a lot if anything, but after the initial diagnosis and deductible, that condition is reimbursed at 90% for the life of the pet. At least that's how my plan works. Their may be other programs that work differently, I just don't know