General (Details 12) (USD $)	3 Months Ended		9 Months Ended					9 Months Ended	12 Months Ended	9 Months Ended	12 Months Ended			9 Months Ended	12 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013	Dec. 31, 2013	Sep. 30, 2014 Customer agreements and lists	Dec. 31, 2013 Customer agreements and lists	Sep. 30, 2014 Customer agreements and lists Minimum	Dec. 31, 2013 Customer agreements and lists Minimum	Sep. 30, 2014 Customer agreements and lists Maximum	Dec. 31, 2013 Customer agreements and lists Maximum	Sep. 30, 2014 Provider networks and other	Dec. 31, 2013 Provider networks and other	Sep. 30, 2014 Provider networks and other Minimum	Dec. 31, 2013 Provider networks and other Minimum	Sep. 30, 2014 Provider networks and other Maximum	Dec. 31, 2013 Provider networks and other Maximum
Summary of intangible assets
Estimated Useful Life								2 years 6 months	2 years 6 months	18 years	18 years			1 year	1 year	16 years	16 years
Gross Carrying Amount	$ 262,403,000		$ 262,403,000		$ 175,583,000	$ 249,390,000	$ 163,990,000					$ 13,013,000	$ 11,593,000
Accumulated Amortization	(122,090,000)		(122,090,000)		(105,889,000)	(115,598,000)	(100,482,000)					(6,492,000)	(5,407,000)
Net Carrying Amount	140,313,000		140,313,000		69,694,000	133,792,000	63,508,000					6,521,000	6,186,000
Amortization expense	6,600,000	2,300,000	16,200,000	6,900,000
Estimated amortization expense in future
2014	22,800,000		22,800,000
2015	25,000,000		25,000,000
2016	20,700,000		20,700,000
2017	16,900,000		16,900,000
2018	$ 15,400,000		$ 15,400,000