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Revenue, Deferred Revenue, Deferred Costs and Other - Disaggregation and Other (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Revenue
Revenue	$ 453,675	$ 180,799
Accounts receivable, net of allowance for doubtful accounts	178,341		$ 169,281
Net increase in deferred revenue	18,400	4,800
Revenue recognized, included in deferred revenue balance at beginning of period	32,700	8,700
Access Fees Revenue
Revenue
Revenue	388,156	137,053
Access Fees Revenue \| United States
Revenue
Revenue	350,868	107,939
Access Fees Revenue \| Foreign.
Revenue
Revenue	37,288	29,114
Visit Fee Revenue
Revenue
Revenue	54,462	43,746
Visit Fee Revenue \| United States
Revenue
Revenue	54,340	43,484
Visit Fee Revenue \| Foreign.
Revenue
Revenue	122	262
Other
Revenue
Revenue	11,057	0
Other \| United States
Revenue
Revenue	10,671	0
Other \| Foreign.
Revenue
Revenue	$ 386	$ 0