Asking "Do casinos pay out in cash?" comes down to adding up costs. The price of moving money in and out of a casino is rarely one number. A fee can come from the operator, the payment method or the bank, and a currency conversion can hide inside an exchange rate that looks close to the market one. Laying the parts out before the first deposit gives the real cost of every payment.
Operator fees usually attach to withdrawals. Some sites charge a flat amount for each payout, others a percentage, and many waive the fee for one or two withdrawals a month and charge for the rest. A few charge for withdrawing a deposit that was never played through, which is aimed at people using the casino to move money. The fee table in the payment terms lists each case, and it changes more often than the rest of the terms.
Payment methods add costs of their own on top of anything the casino charges. Wallet providers often take a percentage when money is loaded or withdrawn to a bank, card issuers may book a casino payment as a cash advance, and crypto transfers pay a network fee set by traffic at the moment of sending. None of these appear in the casino's terms, so the method's own price list is the only place to see them before paying.
Mismatched currencies can mean two conversions on the way in and two on the way out, each with a margin built into the rate.
Many waive the fee for one or two withdrawals a month and charge for any further requests in the same month.
Usually not, because a chargeback tends to close the account, freeze the balance and bring a debt collection claim; the dispute section of the terms gives the safer route.
Some casinos charge an inactivity fee on accounts left untouched for months, slowly draining a forgotten balance.