We have PetFirst for Gia and Po'boy, and ASPCA for Moe Moe and Apu, because they were too old to be accepted by PetFirst. PF has been great to us, they paid out a huge chunk when Butkus was sick with no issue. My dad predicted that after having to pay out so much on him, they'd drop him after the year was up. Not only did they not drop him, they lowered our premiums. The one complaint I have about them is that it's a hassle to make a claim....You must mail in the claim (no fax or email), and if it's the first occurance of the issue, you have to also send in the past 12-months vet records. But their customer services is fabulous, we'd call in and the people on the phone would remember our name and situation, which was comforting.
ASPCA is much easier in terms of filing claims, and they reimburse quickly, but again, they only reimburse 80% of 'average expense', and while Madison isn't as exorbitant as Boston, the 'average' was still a bit below what we actually paid.