Millions of Americans with employer-sponsored health insurance nevertheless are paying most health care expenses out of pocket – or delaying care altogether.

"Both my parents died in their 40s from heart attacks," a 42 year old said in response to a survey by Paytient. "I had been having some chest pain and was ordered to have a stress test. I was told I would have to pay $250 up front. I still haven't had the test."

As many as 69 million workplace-insured Americans were primarily self-paying for care in 2023 because they had not exceeded their deductible, the study found. Forty percent of workplace-insured Americans reported delaying care because of cost, which negatively affected their mental health, workplace culture and productivity. One in six respondents reported that their work was affected by a health issue they couldn't afford to treat, and 69% of this group admitted being distracted by pain at work. Among the other findings:

• Forty-five percent of employed Americans with insurance didn't meet their single coverage deductibles in 2023. On average, they were $1,482 short of meeting their deductible.
• Of those who said their work was affected, 31% reported having a panic attack at work.
• Of those affected by delayed care, 19% have spent time working second jobs during work hours to earn money for health care, and 31% have lied to their boss about what they are doing while dealing with delayed care consequences.
• Seventeen percent of workplace-insured Americans have left their jobs to afford better health care.
• Eighteen percent of workplace-insured employees have been unable to pay a medical bill under $500.

Related: Despite employer insurance, Americans unprepared for medical bills, delay care