They will happily take your money and report that SMS are being delivered when they're not. They implement the most bureaucratic nightmarish processes for vetting brands which are impossible to do via the UI, and must only be done through broken/bizarre API calls that were clearly cobbled together without any design considerations. Maybe you get it all to work, but then after deliverability customer complaints a month later, you hear from Twilio that something broke on their end and you need to re-submit the vetting.
Having a major production issue? Well, you too can get a response in 3 hours by forking over 4% of your spend or $250 minimum, whichever is greater (how does that even make sense? Why should I pay more than a minimum?). And the response right at the end of the 3 hour window will consist of "We have received your issue and are passing it to the relevant team" which resets the 3 hour window. Whoops it looks like you're outside of business hours now, we'll get to it tomorrow. Unless you want to upgrade to the 8% monthly spend or $5000 minimum plan?
All that said, Twilio can burn. Burn or get their act together. I hope they get eaten by a better service though, truly.