$\backslash$table$[[\backslash$table$[[$SERVICE$],[$DATE$]],$PT NAME,$\backslash$table$[[$PROC$],[$CODE$]],\backslash$table$[[$DIAG$.],[$CODE$]],\backslash$table$[[$SERVICE$],[$DESCRIPTION$]],$CHARGE,$\backslash$table$[[$INS$.],[$PAID$]],$ADJ.,$\backslash$table$[[$PT$],[$PAID$]],$AMT DUE$],[,,,,,,,,,\backslash$table$[[$DUE: APRIL$],[$STATEMENT$],[$$$245\mathrm{.}00]]],[\frac{05}{24}\frac{?}{2029},$Ferrar, Gail,$99213,$N$94\mathrm{.}6,$EP OV$,100\mathrm{.}00,80\mathrm{.}00,-0-,-0-,],[,,88150,,$Pap Smear,$30\mathrm{.}00,24\mathrm{.}00,-0-,-0-,]]$

Case $14\mathrm{.}2$ Preparing Insurance Communications

LO $14\mathrm{.}5$ Andrea Martini owes $$400$ to Valley Associates, PC for her son Ben's visit last month. Her account number is RR $109.$ Ben is a dependent on her insurance, Amerigo Health Plan, which has paid its portion on the account. The account is at more than thirty days past due. Draft a collection letter requesting payment.