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Equity method investment Equity method investment - Financial Position and Results of Operations (Details) - Bankers Healthcare Group, LLC - USD ($) | 12 Months Ended
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Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Schedule of Equity Method Investments [Line Items] |  |  |
Assets | $ 459,816,000 | $ 330,030,000 |
Liabilities | 324,211,000 | 224,837,000 |
Equity interests | 135,605,000 | 105,193,000 |
Total liabilities and equity interests | 459,816,000 | 330,030,000 |
Equity Method Investment, Summarized Financial Information, Income Statement [Abstract] |  |  |
Revenues | 220,253,000 | 160,209,000 | $ 136,693,000
Net income, pre tax | $ 104,297,000 | $ 77,941,000 | $ 67,135,000

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