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Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended
--- | --- | ---
Sep. 30, 2019 | Sep. 30, 2018 | Sep. 30, 2019 | Sep. 30, 2018
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | $ 2,781,169 | $ 2,670,701 | $ 8,150,386 | $ 7,980,178
Other revenues | 126,886 | 188,606 | 359,198 | 639,387
Total revenues | 2,904,078 | 2,847,330 | 8,489,895 | 8,583,727
Intersegment Elimination |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Total revenues | (35,845) | (33,785) | (103,559) | (91,691)
Medicare and Medicare Advantage |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | 1,558,890 | 1,513,191 | 4,572,599 | 4,524,449
Other revenues | 65,759 | 130,746 | 191,472 | 427,532
Medicaid and Managed Medicaid |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | 176,292 | 159,165 | 490,723 | 466,948
Other revenues | 227 | 12,042 | 327 | 43,991
Other Government Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | 207,931 | 193,958 | 597,866 | 580,548
Commercial Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | 866,229 | 817,834 | 2,562,120 | 2,436,338
Other revenues | 33,503 | 20,205 | 98,428 | 77,633
Other |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | 31,092 | 33,974 | 79,919 | 117,979
U.S. dialysis and related lab services |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Total revenues | 2,659,065 | 2,551,377 | 7,782,735 | 7,639,101
U.S. dialysis and related lab services | Intersegment Elimination |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Total revenues | (32,362) | (25,424) | (93,337) | (63,943)
U.S. dialysis and related lab services | Medicare and Medicare Advantage |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | 1,558,890 | 1,513,191 | 4,572,599 | 4,524,449
U.S. dialysis and related lab services | Medicaid and Managed Medicaid |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | 176,292 | 159,165 | 490,723 | 466,948
U.S. dialysis and related lab services | Other Government Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | 116,984 | 113,043 | 333,675 | 330,500
U.S. dialysis and related lab services | Commercial Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | 828,953 | 786,470 | 2,458,360 | 2,366,182
U.S. dialysis and related lab services | Other |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | 10,308 | 4,932 | 20,715 | 14,965
Other—Ancillary services and strategic initiatives |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Total revenues | 245,013 | 295,953 | 707,160 | 944,626
Other—Ancillary services and strategic initiatives | Intersegment Elimination |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Total revenues | (3,483) | (8,361) | (10,222) | (27,748)
Other—Ancillary services and strategic initiatives | Medicare and Medicare Advantage |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | 65,759 | 130,746 | 191,472 | 427,532
Other—Ancillary services and strategic initiatives | Medicaid and Managed Medicaid |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | 227 | 12,042 | 327 | 43,991
Other—Ancillary services and strategic initiatives | Other Government Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | 90,947 | 80,915 | 264,191 | 250,048
Other—Ancillary services and strategic initiatives | Commercial Payors |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Patient service revenues | 37,276 | 31,364 | 103,760 | 70,156
Other revenues | 33,503 | 20,205 | 98,428 | 77,633
Other—Ancillary services and strategic initiatives | Other |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Other revenues | $ 20,784 | $ 29,042 | $ 59,204 | $ 103,014

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