We had to use our travel insurance a few years ago when I fell getting off a train in Dover, England, on the way to board a cruise ship for a Baltic cruise. We waited an hour for an ambulance to deliver us to an emergency room in Ashford, where X-rays showed a fractured femur. I was readily admitted after the hospital verified coverage with the insurance company. I had purchased "primary" travel insurance, rather than "secondary". My understanding is that primary insurance pays without having to wait for a Medicare supplement policy to act.
I underwent surgery the next day, and then spent eight more days in the hospital recuperating. My husband found a bed and breakfast nearby. When it was time to make arrangements to go home, On Call International, the transport part of the policy, took over. They flew a registered nurse from Florida to the hospital, where she picked us up and escorted us on to British Airways for the flight to Orlando. The nurse was a wonderfully skilled "rescue" nurse who had been in the military. She got us home to The Villages and made sure we had the proper instructions and equipment before leaving.
The hospital bill came to $11,000 (I know, low by American pricing) and it took around two months to be reimbursed. I was in close contact with someone in the hospital's billing system who patiently waited for our policy to pay before demanding payment. So, when insurance settled, I paid the hospital with a credit card, and their rep was grateful that they got reimbursed fully. And we were so grateful to have the travel insurance.
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