We brought our dog in for increased coughing and the vet found that she had a heart murmur so proceeded to do ex-ray's and found she had an enlarged heart. We then had to do an EKG and heart ultrasound. My vet direct billed Trupanion and the claim was instantly paid and I just had to pay my portion. I would highly recommend this company to anyone who has a pet because speaking from experience vet bills can get very expensive and if you don't have insurance there are times that you may be in the position to have to say no to treatment but with Trupanion this decision doesn't have to be made!!!