Some very informative advice has come out of this posting. Thank you all for sharing your advice. My husband did find out yesterday that his friend will hopefully begin the process to be reimbursed from his health insurance company. I hope it doesn't take as long or is as limiting as JJ5's post implied. I know I have learned a lot from their tragic situation. The good news is that his wife, while still in the hospital here, is at least back with their family and we are hopeful for her continued recovery. Again, everyone, Patrick, letour, wj1, et. al., thanks for sharing all of the info for future reference. Have a nice weekend.

We have nice insurance. Even has toll-free numbers in many countries overseas. They contact the hospital or doctor and handle all the bills.

In the late 90's on a trip through Europe my Mom had to be hospitalized in Switzerland, where she received excellent care. She was a Medicare beneficiary (which provides NO out of country coverage)but had enrolled in one of the optional Aetna programs, and they were simply wonderful. The nurse case manager even called me at the hotel to see how I was doing. We never even saw a bill (I have often wondered what it totaled!) A few doors down from Mom in the Swiss hospital was a woman from the US who required medical evacuation, and her famiily was going nuts trying to arrange it with no coverage - the cost is astounding. Chastened by that experience I did some research and learned that we were lucky, that coverage is HIGHLY variable among different plans - not all plans, even of similar type (HMO, PPO, etc.) offer the same coverage when out of the country.
Very few (if any) plans pay for medical evacuation. And even most of the travel policies cover medical evacuation only when certified as medically necessary (in the judgment of the plan's medical director, not you or the treating physician), and not necessarily to home but to the closest facility with the necessary services. Some - but not all - also cover the cost of regular air transport from the place to which the patient is evacuated back home when feasible.
Bottom line: check with your carrier when you start to plan your trip. In fact, check before booking - if it turns out you have no or inadequate coverage you can purchase a policy for the trip, and many waive pre-existing condition requirements if purchased within a specified period of the first payment you make on the trip (Not sure if that includes hotel reservations, though most of us reserve air prior to hotel.)
And remember that "trip insurance" is a vague term - some policies cover only expenses involved with trip cancellation and no medical coverage. Though I am in pretty good health (OK, maybe a little zaftig...)without chronic conditions, after the experience with my Mom I now purchase trip insurance routinely. After checking several places I have come to settle on www.insuremytrip.com - nice array of options, easy to use site, and helpful staff when I called with questions.