Appreciated the detailed breakdown of cost and reimbursement - well laid out and easy to understand. The turn around time of my reimbursement was reasonable. It's disappointing that I am expected to pay the vet up front first, especially for large amounts. My dog needs to go for surgery. It will cost over $3000 - funds which will take me many months to save. If Trupanion could pay my insurance portion to my vet directly, I would be able to get him into surgery now. Since they won't do that, it will be another 4 months before I can afford the surgery. I feel this defeats the purpose of getting insurance.