Forty percent of workplace-insured Americans often delay seeing a physician due to the cost, according to a recent study by Nonfiction Research and commissioned by Paytient, a Columbia, MO-based provider of healthcare affordability options.

“The results of this study spotlight the invisible insecurity of insured Americans as health insurance alone no longer guarantees access to care. Bringing this narrative into the national dialogue on healthcare highlights an opportunity for employers to affordably ensure employees have the security and certainty that they will be able to access and pay for care when they need it,” Paytient founder and CEO Brian Whorley said in a press release

The study included 1,517 people. Most had above-average annual incomes, and almost 20% were making $100,000 a year or more. Almost half worked in managerial positions or at a higher level.

Of the 40% of those who said they are likely to delay care, 32% said that they are likely to delay regular visits and checkups, and 30% said that they are likely to skip the follow-up visit for a specific symptom or condition.

“Both my parents died in their 40s from heart attacks. I had been having some chest pain and was ordered to have a stress test,” one respondent said. “I was told I would have to pay $250 up front. I still haven’t had the test.”

One respondent said that she would put off visiting the doctor or even the emergency department because of the copay.

“I always think of the cost over my health,” the 35-year-old said.

Many of those workplace-insured Americans (38% of the 40%) who delayed care said that their health declined as a result. Postponing a trip to the physician landed many (20%) in the emergency department.

“I left work one day because my blood sugar was too high because I couldn’t afford my insulin, and then I ended up in the emergency room overnight,” one respondent said.

According to the study, more than 10 million workplace-insured Americans have required surgery because they put off treatment for so long.