Quarterly report pursuant to Section 13 or 15(d)

Revenue Recognition - Schedule of Disaggregation of Revenue (Details)

v3.19.1
Revenue Recognition - Schedule of Disaggregation of Revenue (Details) - USD ($)
$ in Thousands
3 Months Ended
Mar. 31, 2019
Mar. 31, 2018
Disaggregation of Revenue [Line Items]    
Total revenues $ 222,451 $ 254,914
Services    
Disaggregation of Revenue [Line Items]    
Total revenues 178,891 211,315
Healthcare insurers    
Disaggregation of Revenue [Line Items]    
Total revenues 105,878 132,253
Government payers    
Disaggregation of Revenue [Line Items]    
Total revenues 29,510 35,190
Client payers    
Disaggregation of Revenue [Line Items]    
Total revenues 38,422 38,032
Patients    
Disaggregation of Revenue [Line Items]    
Total revenues $ 5,081 $ 5,840