(NBC) - Millions of Americans are living without health insurance, and many often forego routine medical care because they can't afford the out-of-pocket costs.
Even in an emergency situation like a heart attack, people without health coverage may think of their wallet before their well-being.
Loretta Arnold, 52, has a significant family history of heart disease. Her mother died young and her father still battles heart problems. But when she started having chest pains recently, she waited 36 hours before making the decision to get help.
"You say to yourself, 'Well, let's see if it goes away, let's see if the pain goes away,' or 'Let's see if it eases up a little bit,'" Arnold said.
A doctor's visit in addition to tests and medications could cost thousands of dollars, and Loretta does not have health insurance.
"I have to be worried when something happens," she explained. "And yet, I also have to consider my financial status."
She's not alone. A new study of heart attack patients finds those without insurance or patients with very limited coverage are more likely to delay going to the emergency room when they're having heart attack symptoms.
That's a huge mistake, according to cardiologist Dr. James Fang of University Hospitals Case Medical Center in Cleveland.
"If you can get to somebody within what they call the golden hour, [the] very first hour that this is occurring, the chances of their long-term survival is very close to patients who never had a heart attack," Fang explained.
That golden hour is often wasted with financial worry.
The question is not "Is my heart OK?" but rather, "How in the world am I going to pay for all of this?"
"When you have to prioritize, you prioritize to keeping a roof over your head and food on the table," Arnold said. "Insurance premiums, they just don't make the top of the list, unfortunately."
Fang said most cities have financial aid programs to help people who can't afford medical care. You can get more information from your doctor's office or nearest hospital.