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Belgians paddle in hollowed-out pumpkins for annual event

admin - Latest News - October 26, 2025
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Belgians paddle in hollowed-out pumpkins for annual event



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Oct. 26, 2025, 5:00 AM EDTBy Berkeley Lovelace Jr.With the cost of health insurance set to rise, some Americans are asking a surprising question: Is it actually cheaper to get medical care without it?The short answer: Sometimes. But not often. And it may require a little — or a lot — of homework. Some hospitals and clinics offer self-pay or cash only discounts for patients who pay without insurance, skipping the paperwork and administrative fees that come with having coverage. Hospitals are required by federal law to make their discounted cash prices publicly available online. An allergy test or an X-ray, for example, may be a few hundred dollars cheaper this way, especially for people with high deductible plans. Nonprofit hospitals must provide charity care, which is free or discounted, to people who can’t afford it, even for those with insurance.But paying outside of health insurance means that cost doesn’t count toward your deductible or out-of-pocket limit — and if you end up needing more medical visits than expected, you could wind up worse off financially.“You have to be really careful,” said Stacie Dusetzina, a health policy professor at Vanderbilt University in Nashville, Tennessee. “The price that you pay with cash, even if they give you some sort of advertised discount, can be more than what you might actually pay through health insurance overall.”The question of whether to opt out of insurance and pay in cash is surfacing as many Americans are expected to face higher premiums next year. Enhanced subsidies, which kept Affordable Care Act premiums lower for many middle-class people, are set to expire at the end of the year without action from Congress. Premiums for people who get their health insurance through their jobs or outside the ACA are also expected to rise next year. Some ACA enrollees are debating whether to drop their coverage entirely — a decision that experts warn could leave them exposed to major medical bills if an unexpected emergency hits. “If you like Russian roulette, then you’ll like to approach health care this way,” said Michele Johnson, executive director of the Tennessee Justice Center, a law firm and nonprofit advocacy group that helps people dispute medical bills. Johnson said “part of the fallacy is that as American consumers, we’re all about, ‘How do I bargain the best deal?’”“Health care is not this way,” she said. “If you’re healthy, you’re basically pushing all the chips out onto the table in hopes that you basically will mostly be healthy.”Losing benefitsInsurance, for all its frustrations, can provide crucial protections: caps on out-of-pocket costs, access to negotiated rates and free preventive care, such as cancer screenings, annual physicals and routine vaccinations.For non-emergency care, a doctor or hospital may require the patient who isn’t using insurance to pay the entire cost upfront or see a different provider, said Erin Duffy, director of research training at the USC Schaeffer Center for Health Policy and Economics.“It does seem risky,” Duffy said. “If you were thinking that you could keep going to the primary care doctor that you’d go to when you were insured, you might find that there’s different financial obstacles.”For those who are healthy, paying in cash can be a smart move for predictable, lower cost-services — such as an X-ray or CT scan, Dusetzina said.“This comes up all the time in the prescription drug world,” Dusetzina said. “People will often fill generic drugs out of pocket because it happens for them to be cheaper to do that than paying with health insurance in some cases.”But patients wouldn’t have access to their insurer’s negotiated rate — the amount an insurance company agrees to pay for a medical service, Dusetzina said. Even if people haven’t reached their deductibles, they still get the negotiated rate, which might be cheaper than paying cash. And whatever they pay wouldn’t go toward their deductible or out-of-pocket limit. “What has historically happened is, if you went to a medical site and you wanted to pay in cash, the price that they start with is often twice as high or more than what the health insurance price would be,” she said. “So, you do lose the benefit of having a negotiated rate going without health insurance.”A person’s savings can disappear fast if something unexpected happens, Johnson said. Emergency room visits, hospital stays or surgeries — even at discounted rates — can cost tens of thousands of dollars. Uninsured patients are billed the full amount. It’s generally not possible to sign up for health coverage after an emergency has already happened, she said. There’s also a narrow period to enroll; in most states, ACA enrollment is Nov. 1 through Jan. 15. Open enrollment for people who get health insurance through their jobs is generally around the same time.“That’s the only time you can sign up until the next year, so essentially, you’re left holding the bag, not just for emergency visits, but for all the follow-up care,” she said. Johnson said that before people even think about negotiating care with a doctor or provider, they must first check if they have a federally qualified health center nearby. The health clinics receive federal grants to provide low-cost care to underserved populations, including the underinsured and the uninsured. “If you need primary care, you can often get primary care at a federally qualified health center,” she said. If specialty care is needed, doctors may negotiate, but they often require people to pay the full amount upfront, Johnson said. If you want to get an idea of how much you could pay, websites like Turquoise Health show the average cash price hospitals may charge for certain medical procedures. If you do get a lower rate from a doctor, the process might not end there, Johnson said. Depending on how complicated the medical procedure is, you may need to get an agreement with the entire health care team involved.“Even if you have a doctor who says, ‘I will do this for you,’ then somehow you have to get an anesthesiologist to do it, and you have to get labs to do it, and you have to get nurses doing it as well,” she said.Duffy said to call the billing office and “ask really specific questions about when you would have to pay, what are the full range of options for both assistance and payment plans that could be helpful to someone who’s uninsured or lower income or just facing a bill you might not be able to pay all at once.”For those in need of emergency care or hospital care, Duffy noted, there is a federal law — the Emergency Medical Treatment and Labor Act — which requires Medicare-participating hospitals to provide care to anyone who comes to the emergency department, regardless of their ability to pay. After that, the person may be able to negotiate with the hospital or provider, or get a payment plan. None of these strategies are particularly useful for people who are not healthy and are likely to use a high amount of health care, said Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University.“The self-pay option will be most attractive to the healthy and well-off patient, who may forgo adequate health insurance,” he said.Berkeley Lovelace Jr.Berkeley Lovelace Jr. is a health and medical reporter for NBC News. He covers the Food and Drug Administration, with a special focus on Covid vaccines, prescription drug pricing and health care. He previously covered the biotech and pharmaceutical industry with CNBC.
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Savewith a NBCUniversal ProfileCreate your free profile or log in to save this articleSept. 29, 2025, 12:13 PM EDTBy Freddie ClaytonLONDON — The royals are in turmoil again.It had all been going so well, with the pomp of President Donald Trump’s state visit and Prince Harry’s tea with King Charles III building a sense of a family steadied after a litany of crises. Then came the fallout. Harry has accused unnamed palace figures of “sabotage” and of planting false accounts of his meeting with his father. Prince Andrew and his ex-wife Sarah Ferguson face renewed scrutiny over ties to the late convicted sex offender Jeffrey Epstein. Meanwhile, Prince William opened up about what he called “the hardest year” of his life.Together, the stories have jolted the palace narrative from triumph to turbulence — with Harry’s latest clash with the British media at the center of the storm.Prince Harry in Nottingham, England, on Sept. 9.Max Mumby/Indigo / Getty ImagesBritain’s The Sun newspaper claimed last week that Harry’s first meeting with the king in two years was “distinctly formal,” claiming the prince had expressed feeling more like an “official visitor” than a son.Harry’s camp rejected that outright. “Recent reporting of The Duke’s view of the tone of the meeting, is categorically false,” a spokesperson told NBC News, referring to Harry’s title, Duke of Sussex. “The quotes attributed to him are pure invention fed, one can only assume, by sources intent on sabotaging any reconciliation between father and son.”The public feud over the meeting has only deepened tensions at a moment when the family is seeking to project unity, and it could set back attempts to mend the relationship, according to NBC News royal commentator Daisy McAndrew.“I think the king will be really disappointed,” she said.Harry had earlier sounded eager to build on the brief tea, emphasizing his desire to spend more time with his father while defending his tell-all memoir in an interview with Britain’s Guardian newspaper following that trip to the U.K.The accusations from Harry’s camp came just a week after the family showcased its finest pomp and pageantry during Trump’s state visit — a triumph quickly overshadowed by a return to all-too-familiar controversy.President Donald Trump and Britain’s King Charles III at Windsor Castle on Sept. 17.Kirsty Wigglesworth / AFP – Getty ImagesWhile Trump’s trip was only briefly marred by the Epstein scandal, the subject was soon back on newspaper front pages with new royal revelations.The king has instructed Prince Andrew and Sarah Ferguson, the Duke and Duchess of York, that they will not be welcome at the royal Christmas, according to weekend reports in Britain’s Telegraph and Sunday Times newspapers that cited multiple sources.Buckingham Palace did not respond to requests for comment on the report and on the statement from Harry’s spokesperson.That comes after Ferguson was dropped as a patron by a number of charities following a newly surfaced email that revealed she had referred to Epstein as a “supreme friend,” despite the disgraced financier’s conviction on sex offenses. A spokesperson for the duchess said the email was sent to counter a threat Epstein had made to sue her and accuse her of defamation.The disclosure reignited scrutiny of royal ties to Epstein, long centered on Andrew.The palace will hope, McAndrew said, that something else will “come along to take the attention away.”“The problem with Andrew is he’s always grabbing the attention back,” she said.While at odds with itself in recent years, the royal family has also been buffeted by external crises.William described 2024 as the most challenging year of his life in comments that aired Sunday — a period that saw both his wife, Kate, the Princess of Wales, and his father undergo cancer treatment.“I’d say 2024 was the hardest year I’ve ever had,” he said, speaking to “Schitt’s Creek” star Eugene Levy on his show “The Reluctant Traveler.” William, the heir to the throne, added: “Life is said to test us as well, and being able to overcome that is what makes us who we are.”Freddie ClaytonFreddie Clayton is a freelance journalist based in London. 
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