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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, 2019 | Dec. 31, 2018 | Dec. 31, 2017
Schedule of Equity Method Investments [Line Items] |  |  |
Assets | $ 840,398,000 | $ 459,816,000 |
Liabilities | 641,037,000 | 324,211,000 |
Equity interests | 199,361,000 | 135,605,000 |
Total liabilities and equity interests | 840,398,000 | 459,816,000 |
Equity Method Investment, Summarized Financial Information, Income Statement [Abstract] |  |  |
Revenues | 366,500,000 | 220,253,000 | $ 160,209,000
Net income, pre tax | $ 182,462,000 | $ 104,297,000 | $ 77,941,000

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