I signed up my dog last fall when she was a puppy. I initially chose Trupanion because they were the only insurance company at the time that offered a hip dysplaysia component. I was initially very impressed with the personal and quick service I receieved when phoning to ask questions, and ultimately, when signing up.
Just two weeks ago, I had my pup in at the vet for an ear infection. Trupanion was great - I had my reimbursement check in less than a week. Also, I logged onto their site prior to submitting my claim and used the "chat" function to ask a question. I was so impressed at the ease and speed of getting my question answered.
I am a little disappointed that Trupanion doesn't pay for exam fees, but overall, I'm extremely pleased with the service we have received.