Access Fund · Access Fund · a ledger, not a charity page
Pays the lab, the practice, the pharmacy or the vendor. Never the person.
A design for a fund that pays the lab, practice, pharmacy or vendor, never the person. It has not opened.
Access Fund · Access Fund · a ledger, not a charity page
Pays the lab, the practice, the pharmacy or the vendor. Never the person.
A fund that pays a payee directly for one of four things, decided by patients reading blind, with every line public to the cent once a line exists. This is the design. It has not opened.
This month
no month has runPool this month
—Awarded
—Waiting for the 1st
—Median wait
—Refused
—
Pool spent this month
—Pool resets
not scheduledNext committee draw
not scheduledMonthly close
not scheduled
What it pays for, and the whole of the rules
- A lab test a plan deniedThe denial or the not-covered line on the EOB is the proof. Paid to the lab.Any assay a plan denied or excluded. Not a test that was covered with a co-pay.
- A first visit with a Lyme-literate clinicianOne first visit per person, ever. Paid to the practice. The clinician need not be in our directory.Follow-ups are not in scope.
- A prescription a plan will not coverThe pharmacy’s not-covered receipt or the plan’s letter. Paid to the pharmacy.Never a supplement, even one a clinician wrote down.
- A product marked “Access Fund eligible” on a shelfThe vendor ships at list price and takes no commission on the order. Paid to the vendor.Only listings carrying the badge.
The rules, in full
- Eligibility, as designed
- One test: a cap per person per rolling year, and nothing else — no income test, no letter of need, no sentence about how bad it is. Who the fund opens to, and when, is a decision not yet taken; nothing here is a promise to you.
- The cap
- A per-person cap in any rolling twelve months [ILLUSTRATIVE]. The cap is the whole test. It rises with the pool by a published formula, never by a vote.
- Payout
- Direct to the lab, practice, pharmacy or vendor. Money never passes through the person who asked.
- Who decides
- Three members of a five-person patient committee read each request. Majority decides, in writing, within seven days. The committee rotates every quarter; seats are drawn by lot from members who volunteered and have held a record for at least six months.
- Terms
- A seat is one calendar quarter, not renewable for four quarters. Two alternates are drawn with the five; an alternate sits when a reader recuses, steps down or misses a 72-hour deadline, so three reads are always three.
- Quorum
- Three reads make a decision. If a reader is unavailable, the alternate is drawn in the same day. No request is ever decided by two.
- Conflict of interest
- Before each read a reader declares: I do not know who asked, and the payee is not my clinician, my pharmacy or my employer. If either is false the read passes to an alternate. The declaration is logged; the reason is not.
- What a reader sees
- The category, the payee, the amount, the invoice or denial, and one optional sentence. Never the name. Never the record. Not even the request number, until the decision is in.
- Refusals
- Four grounds only: outside the four categories, over the cap, the payee will not take a direct payment, or a duplicate of an award in the last 90 days. A refusal names its ground in one sentence. There is no fifth ground.
- Appeal
- One appeal per request. It is read by a fresh trio; anyone who read the first time is excluded. The appeal reads the same paper; no new story is asked for.
- Fight the denial first
- A denial is fought before it is funded. The insurance kit assembles the facts an appeal rests on from your record; the fund asks whether you sent an appeal, and a reader sees the answer as a fact. The fund still pays while the appeal runs — and if the plan later pays, the payee refunds the fund and the cap comes back the same day.
- The pool
- Each month’s pool is the smaller of the balance and a published floor, so the fund lasts. When a month’s pool is spent, requests wait for the first of the next month in the order received. Waiting is not a refusal.
- Rollover
- Unspent pool rolls forward at most two months. Anything older goes to the waitlist, oldest request first, on the 1st.
- Amendment
- The rules change once a year, in January, by a vote of everyone who has ever held a seat. Every change is a dated line in the version history; nothing is edited in place.
Who decides
Seats
—five, plus two alternatesDecisions this quarter
—majority of threeMedian days
—ask to decisionDrawn from
—volunteers with a record
The published formulas — their shape, without their constants, which are not decided:
- pool
- the smaller of the balance and a published floor, rising with trailing inflow
- cap
- a rounded share of the pool, so one award cannot take more than a stated fraction of a month
Reviewed at each quarter close; the arithmetic is public; nothing is a vote.
What the fund never does
- Rank people by need, story or deservingness — there is no field for it.
- Name anyone who asked, or anyone who was helped. Institutions that give may be named; people never are.
- Let a donor, vendor or clinician see who was helped or direct where money goes.
- Pay a person. Every award goes to a payee that issued an invoice.
- Run out quietly. A spent pool shows on the public page as a spent pool.
The ledger, to the cent
Every line since the fund opened. Awards name the payee and the category, never the person. Each line is hash-chained to the one before.
| Date | Line | In / out | Balance |
|---|
No ledger exists — the fund has not opened. When it does, every line appears here, hash-chained, with CSV and JSON beside it.
Awards per month
not drawn · nothing has happened
Refusals, by ground
four grounds, no fifthnot drawn · nothing has happened
How the money moved
In
—The pool
—Out · to payee classes
—Held for the 1st
—
Awards, anonymised
What · when · amount, and never who. Nothing has been awarded.
Every payee, and what it was paid
No payee is on file. A payee is a lab, a practice, a pharmacy or a vendor that issued an invoice — never a person.
Questions people ask
Do I have to appeal the denial first?
You are asked to. The insurance kit assembles the facts an appeal rests on from your record — dates of service, results, what has been tried — and prints them as one document; it does not write the appeal or send it. The fund does not wait for the answer — it pays the payee now — but if you have not sent an appeal you are asked why, and the reader sees that. If the plan later pays, the payee refunds the fund and your cap is restored.
Why would my ask wait?
Because the month’s pool was spent before three readers got to it. Your request keeps its place in the order received and is paid on the 1st. Nobody decided against you; the arithmetic ran out of month.
Who sees my name?
Nobody on the committee, ever. One staff member sees it on the invoice at the moment of paying it; that opening is logged under their name and you can see the log line in your own request.
Can I ask for part of an invoice?
Yes. Tick “accept a partial award” and the committee can award up to your cap and leave the rest to you. Without the tick it is all or a refusal on the cap.
Why is there a cap, and how is it set?
It is a published share of a month’s pool, so one award cannot empty a month. When the pool rises, the cap rises with it, without a vote.
What is a duplicate?
The same payee and the same thing for the same record inside 90 days. A second lab test of a different kind is not a duplicate; the same test re-run is.
Can I appeal twice?
No. One appeal, read by three people who did not read the first time. After that the ground stands and you may ask again with a different payee or when the cap comes back.
Does asking go in my record?
No. A request is its own object with its own life. Your record is never read by the fund and is never written to by it.
How would I know the ledger is real?
Every line carries a hash of itself and the line before, so a changed line breaks every line after it. The bank statement is reconciled monthly and the reconciliation is itself a ledger line.
The one place a name is seen
The invoice, at the moment of paying it — one staff member, one logged action under their name, visible as a log line in the request it belongs to.
What is kept, and for how long
A refused request’s text and paper are deleted twelve months after the decision. The ledger line, if any, is forever.
Something looks wrong?
A concern route and an independent ombuds are part of the design [ILLUSTRATIVE]; neither exists yet. There is no address to write to about a fund that has not opened.
Read it by machine
A ledger endpoint, CSV and JSON, with the chained hashes — designed. No endpoint exists.
Rules, versioned
Rules are versioned; every change is a dated line and nothing is edited in place. The kit’s own version log, amounts removed, dates omitted [ILLUSTRATIVE]:
- v1.0Founding text: four categories, a per-person cap, a monthly pool, three grounds for refusal, a five-seat quarterly committee.
- v1.1Appeals read by readers who did not sit the first time. “Waiting is not a refusal”, in those words.
- v1.2Two alternates drawn with each committee; a 72-hour read deadline. Term non-renewable for four quarters.
- v1.3A fourth ground: duplicate inside 90 days. A conflict-of-interest declaration before each read. Published cap and pool formulas and a two-month rollover. One appeal per request, a fresh trio.