The first "no" is a feature.
The medical-tourism playbook is to say yes. Inquiry forms convert to deposits convert to treatments; the clinics that say yes the loudest are the clinics that grow the fastest. We do not run that playbook. A meaningful share of inquiries are declined before they reach a deposit, and another fraction are redirected after the consult call.
The declines fall into a small number of repeating categories. None of them are personal. All of them protect the patient from a treatment that is unlikely to help or likely to harm, and protect the practice from outcomes that would not survive honest follow-up.
The numbers, stage by stage.
For the inquiries that arrive in a typical month, the rough shape of the funnel looks like this. The proportions move a little month to month, but the shape holds.
Each gate removes mass.
Blue = passes through to the next gate. Red = filtered out at this gate. How much is still in the running shows at the right.
A meaningful share of inquiries do not become treatments. Some are filtered at the phone screen, more at the records review, and a final group at the consult call. A small additional fraction self-decline after the consult.
Why people are turned away.
The decline reasons cluster into a small number of categories. Knowing them in advance saves people a phone call and lets them know whether to inquire at all. Click a segment to read.
Of those declined, here's why.
Active malignancy
Unmanaged infection
Indication mismatch
Pregnancy, organ failure
Expectation mismatch
Active malignancy.
Patients with active or recently-treated cancer are declined for IV MSC therapy. This is caution, not a claim about your case: we will not run cell therapy alongside an active cancer. Post-remission cases are reviewed individually by our medical team.
The four gates, in order.
Each gate exists because something can be learned at that point that cannot be learned later. Press play to walk through, or click any gate.
Four gates. Each catches what the previous can't.
No deposit until Gate 04 produces a written physician sign-off.
Phone screen · 15–20 minutes.
An intake coordinator runs a structured questionnaire: indication, age, comorbidities, current medications, prior cell therapy, recent imaging, and the patient's reason for inquiring. The goal is to identify obvious declines fast: active cancer, active infection, pregnancy, indication mismatch. No clinical promises are made.
Records review · physician-read.
Recent labs (CBC, CMP, infectious panel), imaging where relevant (provided, or performed on site at Hospital Angeles), prior specialist notes. Reviewed by a Celva physician, not a coordinator. The reviewer is looking for what the phone screen could not catch: lab abnormalities, contraindications visible only on imaging, prior treatments that change the calculus.
Consult call · not a salesperson.
A clinical conversation, not a sales pitch: plausible benefit, expected timeline, risks, alternatives, the honest "this is what we can and cannot do." Our clinical team runs the call, and you can ask to speak with the treating physician directly. Either way, a Celva physician reads your records and signs the case in writing before any deposit.
Final medical sign-off · in writing.
Before scheduling, the physician signs the case in writing: indication, dose, source, planned protocol, identified risks. If anything changed at the consult, the case can still be declined here. The sign-off is what unlocks scheduling; nothing scheduling-side moves until it exists.
The conditions we say yes to.
Three columns. Not a complete list, a representative sample of how categories sort. If your condition isn't here, the phone screen is the right next step.
Treated · Case-by-case · Declined.
Hover a column to highlight its full row of examples. The yellow middle is where the most careful conversations happen.
Osteoarthritis (knee, hip)
Established mechanism; published evidence for symptomatic improvement.
IV or local depending on joint.Autoimmune (RA, lupus, MS)
Plausible immunomodulatory mechanism; realistic expectations.
Not a cure; symptomatic.Post-injury / orthopedic
Local application; established orthobiologic context.
MRI required for joints.Crohn's, ulcerative colitis
Plausible mechanism, mixed published data.
Recent GI workup required.Chronic fatigue, long COVID
Reviewed against current evidence; expectations carefully framed.
Symptom diary + prior workup.Cognitive / neurodegenerative
Evidence remains preliminary; we are honest about that.
Never offered as a cure.Cardiac & pulmonary
Stable, controlled disease is treatable; unstable or decompensated states are reviewed individually.
Recent cardiac workup required.Active malignancy
Categorical decline regardless of cancer type or stage.
Post-remission reviewed individually.Pregnancy / breastfeeding
Categorical decline; insufficient safety data in this population.
Deferral, not permanent.The yellow column is where the most careful conversations happen. The decline column is short and definitive, no amount of consult-call charm changes those answers.
Not every inquiry becomes a patient.
The decline is not punitive, it is the first promise Celva makes. Four gates, five recurring decline categories, no deposit until a Celva physician signs the case. If your inquiry passes all four, it's because there is real reason to believe the treatment can help; if it doesn't, you save a trip and a deposit.
The clinics that say yes the loudest are the clinics that grow the fastest. The right question for any program isn't "will you treat me?" It's "what would make you say no?"